局部枸橼酸抗凝在重症创伤患者连续性静脉-静脉血液滤过中的应用  

The application of regional citrate anti-coagulation for continuous veno-venous hemofiltration in severe trauma patients

作　　者：武子霞[1] 穆恩[1] 翁欣[1] 张仲汇[1] 刘志永[1] 张桢铭[1] 王翦[1] 刘奕[1] 张伟[1] 卢晋[1] 

机构地区：[1]天津市天津医院重症医学科,天津300211

出　　处：《中国中西医结合急救杂志》2016年第3期307-309,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的探讨局部枸橼酸抗凝法（RCA）在重症创伤患者连续性静脉-静脉血液滤过（CVVH）中的效果及安全性。方法选择天津市天津医院重症医学科2013年6月至2015年8月收治的64例需行连续性肾脏替代治疗（CRRT）的重症创伤患者，根据患者的病情需要分为两组，其中无抗凝CVVH组（无抗凝组）29例，RCA—CVVH组（RCA组）35例。比较两组患者滤器使用时间、治疗后活化部分凝血活酶时间（APTT）、酸碱平衡、血游离钙（[Ca^2＋]i）、血钠（Na^＋）浓度及临床出血发生率方面的差异。结果RCA组滤器使用时间较无抗凝组明显延长（h：50．7±11．3比4．9±1．2，P〈0．01），但两组治疗后APTT（S：30．7±8．8比32．1±7．3）、pH值（7．41±0．09比7．40±0．07）、[Ca^2＋]i（mmol／L：2．13±0．20比2．21±0．17）、Na^＋（mmol／L：139±8比141±6）]方面比较差异均无统计学意义（均P〉0．05）。RCA组出血发生率较无抗凝组降低[2．9％（1／35）比13．8％（4／29）]，但差异无统计学意义（P〉0．05）。结论RCA用于重症创伤患者是一种安全、有效的CRRT方式，不影响内环境的稳定，不增加临床出血事件的发生。Objective To investigate the efficacy and safety of regional citrate anticoagulation （RCA） for continuous veno-venous hemofiltration （CVVH） in patients with severe trauma. Methods Sixty-four patients with severe trauma who needed to apply continuous renal replacement therapy （CRRT） and were admitted into the department of critical care medicine in Tianjin Hospital from June 2013 to August 2015 were enrolled in the study. According to the patient＇s actual condition, they were divided into two groups： no anticoagulant group （29 cases） and RCA group （35 cases）. The filter lifetime, after treatment the activated partial thromboplastin time （APTT）, acid-base balance, free calcium （[Ca2＋]i） and serum sodium （Na＋） concentrations, bleeding episodes were compared between the two groups. Results The average filter lifetime in RCA group was longer than that in no anticoagulant group （hours： 50.7 ± 11.3 vs. 4.9 ± 1.2, P 〈 0.01）. After the end of treatment, the levels of APTr （s： 30.7 ± 8.8 vs. 32.1 ± 7.3）, pH value （7.41 ± 0.09 vs. 7.40 ± 0.07）, [Ca2＋]i （retool/L： 2.13 ± 0.20 vs. 2.21 ± 0.17）, and Na＋ （retool/L： 139 ± 8 vs. 141 ± 6） were of no significant differences between the RCA group and the no anticoagulant group （all P 〉 0.05）. The incidence of clinical bleeding in RCA group was lower than that in no anticoagulant group [2.9% （1/35） vs. 13.8% （4/29）], but the difference was not statistically significant （P 〉 0.05）. Conclusions RCA-CVVH is a safe and effective therapeutic method in patients with severe trauma who need for CRRT, the stability of internal environment is not affected and no incidence of clinical bleeding event is increased.

关 键 词：局部枸橼酸抗凝 连续性肾脏替代治疗 重症创伤 

分 类 号：R692.5[医药卫生—泌尿科学]