分段枸橼酸抗凝进行含钙透析液高通量血液透析的临床观察  

Observational study of segmented citrate anticoagulation in high flux hemodialysis with calcium-containing dialysate

作　　者：张东亮[1] 张潘[1] 张周沧[1] ZHANG Dong-liang ZHANG Pan ZHANG Zhou-cang(Blood Purification Center, Peking University International Hospital, Beijing 102206, China)

机构地区：[1]北京大学国际医院血液净化中心,北京102206

出　　处：《中国血液净化》2016年第12期686-690,共5页Chinese Journal of Blood Purification

摘　　要：目的观察分段枸橼酸抗凝法(segmented citrate anticoagulation,SCA)进行含钙透析液高通量血液透析(high flux hemodialysis,HFHD)的安全性和有效性。方法对高出血风险的维持性血液透析患者进行SCA-HFHD治疗,监测患者血压、脉搏、透析治疗参数、体外循环不同位置血钙离子浓度(Ca^(2+)),测算尿素下降率(urine reduction ratio,URR)和溶质清除指数(Kt/V)评估单次透析充分性、透析后管路凝血情况,对发生凝血与未发生凝血的治疗中上述参数进行对比分析。结果共观察了19例患者133次SCA-HFHD治疗,有效血流量(205.8±22.5)ml/min,透析液流量(370.7±105.0)ml/min,持续泵入4%枸橼酸三钠的速度为:透析器前(314.6±14.2)ml/h,透析器后(53.5±6.3)ml/h;体外循环动脉端Ca^(2+)在(0.76±0.16)mol/L,静脉回血端Ca^(2+)在(0.45±0.14)mmol/L;单次治疗URR为65.9%±9.8%,Kt/V为(1.38±0.31);SCA-HFHD治疗前后血红蛋白浓度稳定(94.8±13.8)g/L对(94.3±12.0)g/L,t=0.481,P=0.639);无凝血治疗80例次(60.2%);与发生凝血的治疗相比,未发生凝血的治疗在第120分钟时的静脉压显著低于前者(72.0±37.7)mm Hg对(91.1±31.5)mm Hg,t=-3.055,P=0.003。结论对于高出血风险的患者,SCA-HFHD是安全有效的。Target To observe the safety and efficacy of segmented citrate anticoagulation （SCA） in high flux hemodialysis （HFHD） with calcium-containing dialysate. Methods The maintenance hemodialysis patients with high risk of bleeding were treated by SCA-HFHD. Clinical parameters were observed regularly during the treatment, including blood pressure, pulse, dialysis parameters, and blood ionized calcium levels （Ca^2＋） at different points in the dialysis pipeline. The urine reduction ratio （URR） and Kt/Vwere calculated, and the coagulation situation in dialyzers and tubes were recorded. The above parameters were compared between sessions with and without coagulation. Results A total of 133 SCA-HFHD sessions in 19 patients were studied. The mean effective blood volume was 205.8±22.5 ml/min, mean dialysate volume was 370.74±105.0 ml/min, and mean volume of 4% trisodium citrate was 314.6±14.2 ml/h before dialyzer and 53.5±6.3 ml/h after dialyzer. The mean blood Ca2＋ level was 0.76±0.16 mol/L at inlet point of blood line and 0.45±0.14 mmol/L at outlet point of blood line. The mean URR was 65.9%±9.8% and Kt/V was 1.38±0.31 in a session. Hemoglobin levels before and after SCA-HFHD treatments were stable （94.8±13.8 g/L vs. 94.3±12.0 g/L, t=-0.481, P=0.639）. There were 80 sessions （60.2%） without coagulation. Venous pressures were significantly lower in sessions without coagulation than in sessions with coagulation （72.0±37.7 mmHg vs. 91.1±31.5 mmHg, t=-3.055, P=0.003）. Conclusion SCA-HFHD is a safe and effective treatment for patients with high risk of bleeding.

关 键 词：枸橼酸三钠 抗凝 血液透析 高通量 钙离子 

分 类 号：R318.16[医药卫生—生物医学工程]