局部枸橼酸体外抗凝在高危出血风险患者持续肾脏替代治疗中的应用  

Application of continuous renal replacement therapy with regional citrate anticoagulation in patients at high risk of bleeding

作　　者：王佳[1] 余毅[1] 孙淑清[1] 王琰[1] 林曰勇[1] 陈今[1] 

机构地区：[1]南京军区福州总医院血液净化科,福建350025

出　　处：《中国血液净化》2015年第7期404-407,共4页Chinese Journal of Blood Purification

摘　　要：目的探讨行持续肾脏替代治疗（CRRT）的高危出血风险患者应用局部枸橼酸体外抗凝的效果及安全性。方法选取南京军区福州总医院2014年1月-2015年1月间行CRRT治疗的高危出血风险患者40例,随机分为枸橼酸组20例及对照组20例,枸橼酸组使用局部枸橼酸体外抗凝,对照组使用小剂量低分子肝素抗凝。观察2组的抗凝效果及安全性。结果枸橼酸组与对照组相比,治疗前一般情况及各项检查指标无明显差异（P〉0.05）,治疗后12h、24h、48h不同时间点,APTT低于对照组（F=83.280,61.676,83.836,P均〈0.01）,血Ca、Plt、Hb无明显差异（P〉0.05）;枸橼酸组平均滤器寿命高于对照组（38.1±13.7h vs 26.4±10.1h,t=3.081,P〈0.01）,体外循环凝血发生率低于对照组（12.8%vs 29.2%,χ^2=6.736,P〈0.01）,出血发生率无明显差异（P〉0.05）;枸橼酸组治疗后12h、24h不同时间点,对比治疗前,滤器后离子钙均降低（F=49.510,P〈0.01）,p H值均升高（F=4.102,P〈0.05）,HCO3-均升高（F=4.502,P〈0.05）,外周血离子钙无明显差异（P〉0.05）。结论 CRRT应用局部枸橼酸体外抗凝安全有效,抗凝效果优于小剂量低分子肝素,可作为高危出血风险患者的抗凝选择之一。Objective To investigate the efficacy and safety of continuous renal replacement therapy（CRRT） using regional citrate anticoagulation in patients at high risk of bleeding. Methods A total of 40 patients at high risk of bleeding treated with CRRT in Fuzhou General Hospital of Nanjing Military Command during the period from Jan. 2014 to Jan. 2015 were enrolled in this study. They were divided into citrate group（n=20） and control group（n=20）. Patients in citrate group were given citrate for anticoagulation, and patients in control group were given low molecular weight heparin for anticoagulation. The efficacy and safety were compared between the two groups. Results Before treatment, there were no significant differences in demographic characteristics and laboratory data between the two groups（P〉0.05）. After treatment at different time periods（12h, 24 h and 72h）, APTT in citrate group was lower than that in control group（F=83.280, 61.676 and83.836, respectively; P〈0.01）. Serum calcium, platelet and hemoglobin had no significant differences between the two groups（P〉0.05）. Filter life was longer in citrate group than in control group（38.1±13.7h vs.26.4±10.1h; t=0.381, P〈0.01）. The incidence of clotting in circuit was lower in citrate group than in control group（12.8% vs. 29.2%; χ^2=6.736, P〈0.01）. The incidence of bleeding had no significant differences between the two groups（P〉0.05）. In citrate group after the treatment at different time periods（12h and 24h）,ionized calcium behind filter was lower than that before treatment（F=49.510, P〈0.01）, p H（F=4.102, P〈0.05） and HCO3-（F=4.502, P〈0.05） values were higher than those before treatment, and ionized calcium before filter changed insignificantly compared to that before treatment（P〉0.05）. Conclusion Regional citrate anticoagulation is a safe and effective option for CRRT in patients at high risk of bleeding.

关 键 词：持续肾脏替代治疗 局部枸橼酸体外抗凝 高危出血风险 

分 类 号：R459.5[医药卫生—治疗学]