连续肾脏替代治疗实施枸橼酸盐局部抗凝的临床疗效评价  

The efficacy and safety of regional citrate anticoagulation for continuous renal replacement therapy

作　　者：辛欣[1] 李文雄[1] 赵松[1] 郑悦[1] 黄立锋[1] 隋峰[1] 

机构地区：[1]首都医科大学附属北京朝阳医院SICU,北京100020

出　　处：《中国急救医学》2015年第9期849-854,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的评价枸橼酸盐局部抗凝（RCA）在连续肾脏替代治疗（CRRT）中的临床效果与安全性。方法前瞻性收集2012—07—2013—12我院SICU接受CRRT患者的临床资料，包括每次CRRT是否为近期术后，开始CRRT前当天的血小板（PLT）计数、国际标准化比值（INR）、活化部分凝血活酶时间（APTY）、血清尿素氮（BUN）、肌酐（cr）、总胆红素（TBIL）及急性生理与慢性健康状况评分（APACHEII）和序贯性器官衰竭评分（SOFA）等。记录患者的抗凝方式和抗凝剂使用状况、每次CRRT的滤器寿命、出血状况、酸碱平衡失调与电解质紊乱等并发症发生状况。按抗凝方式将CRRT分为无抗凝组、肝素抗凝组和RCA组。采用生存分析比较不同抗凝方式的滤器寿命；采用多重线性回归分析患者基线特征、抗凝方式与滤器寿命的关系；采用Logistic回归分析患者基线特征、抗凝方式与患者出血风险的关系；采用z。检验比较三组患者CRRT期间出血、血小板减少及代谢性并发症的差异。结果75例危重患者接受了CRRT，共行CRRT295例次。其中无抗凝组97例次，肝素抗凝组110例次，RCA组88例次。无抗凝组、肝素抗凝组、RCA组的滤器寿命分别为（18．24±1．09）h、（24．53±1．60）h和（27．12±1．55）h，肝素抗凝组和RCA组的滤器寿命显著高于无抗凝组（P〈0．01），但肝素抗凝组与RCA组比较差异无统计学意义（P〉0．05）。显著影响滤器寿命的因素包括抗凝方式和血小板计数，对应的回归系数分别为0．20和0．18（P〈0．05）。抗凝方式与出血风险无关（OR3．03，P〉0．05），近期术后是与出血相关的独立危险因素（OR26．67，P〈0．05）；三组患者中出血、血小板下降及代谢性并发症的发生率差异无统计学意义（P〉0．05）。结论CRRT期间RCA效果与普通肝素相当，均优于无抗凝组。滤器寿命主要与抗凝方式和基线Objective To investigate the efficacy and safety of regional citrate anticoagulation in critically ill patients treated with continuous renal replacement therapy （CRRT）. Methods A prospective study was conducted on the patients treated with CRRT in our hospital from July 2012 to December 2013. At start of CVVH, baseline data of the patients was collected, including recent surgery, platelets, international normalized ratio （INR）, activated partial thromboplastin time （APTT）, blood urea nitrogen （BUN） and serum creatinine （ Cr）, total bilirubin （ TBIL）, acute physiology and chronic health evaluation （APACHE Ⅱ ）, sequential organ failure assessment （SOFA）. Also, the survival time of the filters, bleeding complication, acid - base imbalance, electrolyte disturbance were recorded during CRRT. Based on different anticoagulation, the CRRT was divided into three groups：non- anticoagulation group, heparin anticoagnlation group and regional citrate anticoagulation （RCA） group. The survival time of the filters was analyzed among the three groups, the relationship among baseline characteristics, anticoagulation ways and the survival time of the filters was observed by multiple linear regression analysis, and the relationship was analyzed among baseline characteristics, anticoagnlation ways and risk for bleeding complication by Logistic regression analysis. The Bleeding complication, thrombocytopenia, metabolic complication were compared with Chi - square statistics between groups. Results 75 critically ill patients who received 295 times of CRRT. Based on different anticoagulation, with 97 times in non -anticoagulation group, 110 times in heparin anticoagulation group and 88 times in citrate anticoagnlation group. The survival time of the filters was （ 18.24 ± 1.09） hours in no anticoagulation group, （24.53 ＋ 1.60） hours in heparin anticoagnlation group, and （27.12 ± 1.55） hours in RCA group. The survival time of the filters was longer in the heparin anticoagulation gro

关 键 词：连续.肾脏替代治疗(CRRT) 抗凝 枸橼酸盐局部抗凝(RCA) 疗效 

分 类 号：R692.5[医药卫生—泌尿科学]