枸橼酸抗凝在高危出血患者连续性静脉-静脉血液滤过中的应用  

Application of regional citrate anticoagulation in continuous venovenous hemofiltration in patients with high risk of bleeding

作　　者：毕伟红[1] 张艳玲[1] 

机构地区：[1]绵阳市第三人民医院肾内科,四川621000

出　　处：《现代医药卫生》2015年第14期2101-2103,2106,共4页Journal of Modern Medicine & Health

摘　　要：目的观察局部枸橼酸抗凝（RCA）应用于高危出血患者连续性静脉-静脉血液滤过（CVVH）的疗效及安全性。方法选择2012年6月至2014年6月在该院行血液净化治疗中有出血倾向（血小板明显减少或凝血功能异常）的患者45例,排除肝功能异常及低氧血症患者,将其分为RCA组24例和无肝素CVVH组（对照组）21例。监测两组患者血气分析、电解质、游离钙、凝血功能等,观察体外循环凝血情况。结果 RCA组治疗中两泵间活化部分凝血活酶时间（APTT）较治疗前延长,差异均有统计学意义（P〈0.05）;RCA组两泵间游离钙水平在治疗2、4、6 h时明显低于同时间点的体内血游离钙水平,差异均有统计学意义（P〈0.05）,且RCA组在治疗过程中无一例严重低钙血症患者出现。RCA组和对照组患者治疗后碳酸氢根均较治疗前升高,而肌酐水平均较治疗前降低,差异均有统计学意义（P〈0.05）。RCA组透析器凝血程度达0~1级者明显高于对照组,而2~3级者明显低于对照组,差异均有统计学意义（P〈0.05）;RCA组静脉壶凝血的发生率较对照组明显减少,差异均有统计学意义（P〈0.05）。结论高危出血患者行CVVH时,枸橼酸抗凝安全有效,值得在临床上推广应用。Objective To observe the efficacy and safety of regional citrate anticoagulation（RCA） in continuous venove nous hemofiltration（CVVH） in the patients with high risk of bleeding. Methods A total of 45 patients with bleeding tendency（obvious thrombocytopenia or abnormal coagulation function） undergone the CVVH therapy in this hospital from June 2012 to June 2014 were selected by excluding the abnormal liver function and hypoxemia and randomized into the RCA group（24 cases）and the non-heparin CVVH group（control group,21 cases）.The blood gas analysis,electrolytes,free calcium and blood coagulation function were monitored. The blood coagulation situation of extracorpereal circulation was observed. Results The activated partial thromboplastin time（APTT） during treatment in the RCA group was extended compared with before treatment,the difference was statistical significant（P〈0.05）;the free calcium levels in the two pumps at 2,4,6 h of treatment in the RCA group were significantly lower than those of in vivo blood free calcium at the same time points,the differences were statistically significant（P〈0.05）.No case of severe hypocalcemia appeared during treatment in the RCA group. The HCO3 level after treatment in the RCA group and the control group was increased compared with before treatment,while the Cr level was decreased,the differences were statistically significant（P〈0.05）,The blood coagulation degree of dialyzer reaching grade 0-1 in the RCA group was significantly higher than that in the control group,while grade 2-3 was significantly lower than that in the control group,the difference was statistically significant（P〈0.05）. Conclusion In conducting CVVH for the patients with high risk of bleeding,the citrate anticoagulation is safe and effective and deserves to be widely applied in clinic.

关 键 词：柠檬酸盐类 抗凝药 出血 静脉 血液滤过 

分 类 号：R692.5[医药卫生—泌尿科学]