局部枸橼酸抗凝与全身肝素抗凝治疗脓毒症急性肾损伤的效果对比  

Comparative study of regional citrate anticoagulation and systemic heparin in treatment of sepsis-induced acute kidney injury

作　　者：张颖萍[1] 秦龙[1] 刘秋旻 颜卫峰[1] 路建荣[1] 陈喆[1] 

机构地区：[1]北京市海淀医院重症医学科,北京市100080

出　　处：《实用老年医学》2017年第4期370-372,376,共4页Practical Geriatrics

摘　　要：目的比较局部枸橼酸抗凝与全身肝素抗凝在脓毒症急性肾损伤(AKI)治疗中的效果和安全性。方法纳入2013年3月至2016年3月期间的脓毒症AKI病人82例,按照抗凝治疗方法的不同分为观察组(局部枸橼酸抗凝治疗)和对照组(全身肝素抗凝治疗),比较2组的凝血功能、血液净化效果、滤器的使用寿命以及不良事件发生情况。结果治疗后,观察组凝血酶原时间(PT)、活化部分凝血时间(APTT)等凝血指标明显优于对照组,血小板计数(PLT)明显高于对照组,肌酸激酶同工酶(CK-MB)以及肌酐(Cr)水平较对照组显著降低;观察组滤器的使用寿命明显高于对照组,而出血事件发生率明显低于对照组;2组间比较差异均具有统计学意义(P<0.05)。结论局部枸橼酸抗凝治疗对脓毒症AKI病人的凝血功能影响甚微,其可提高血液净化效果,降低出血事件的发生率。Objective To compare the effect and safety of regional citrate acid anticoagulation treatment and systemic heparin in treatment of sepsis-induced acute kidney injury （AKI）. Methods From March 2013 to March 2016, 82 sepsis-induced AKI patients treated with different anticoagulation methods were enrolled and analyzed, and were divided into observation group （regional citrate acid anticoagulation therapy） and control group （systemic heparin therapy ）. The coagulation, blood purification effect, filter life and adverse events were observed and compared. Results After treatment, prothrombin time （PT） and activated partial prothrombin time （APTT） were significantly decreased, and the number of platelets was significantly higher in observation group than that in control group;The levels of isoencymes of creatine kinase（CK-MB） and creatine（Cr） in observation group were significantly lower than those in control group; Filter life in the observation group was significantly higher and the bleeding event rate was significantly lower than that in control group （P〈0. 05）. Conclusions Regional citrate acid anticoagulation therapy can effectively improve the coagulation and blood purification effect, and reduce the incidence of bleeding events for patients with septic-induced AKI.

关 键 词：枸橼酸 脓毒症急性肾损伤 连续性肾脏替代治疗 抗凝 

分 类 号：R459.7[医药卫生—急诊医学]