简化枸橼酸抗凝无肝素透析的疗效观察  

Efficacy and safety of a simplified regional citrate anticoagulation protocol in heparin-free hemodialysis

作　　者：朱淑华 樊蓉 徐斌 龚德华 

机构地区：[1]南京大学医学院附属金陵医院(南京总医院)肾脏科 [2]南京大学医学院附属金陵医院(南京总医院)肾脏科国家肾脏疾病临床医学研究中心全军肾脏病研究所,南京210016

出　　处：《肾脏病与透析肾移植杂志》2017年第4期323-327,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家自然科学基金面上项目(81170708);国家重点研发计划课题(2016YFC0904103)

摘　　要：目的:观察无肝素透析时采用简化枸橼酸抗凝(RCA)方案进行抗凝的有效性及安全性。方法:选择2016年6月~2017年1月在南京总医院国家肾脏疾病临床医学研究中心行维持性血液透析治疗、因各种原因需行无肝素透析患者共42例,采用简化RCA方案抗凝,前期患者采用方案一,后期患者采用方案二,两种方案都不另外补充钙剂。观察抗凝效果、单次透析持续时间及可能出现的不良反应。结果:13例患者采用方案一抗凝,共完成37例次透析,29例患者采用方案二抗凝,共完成129例次透析,所有治疗均未发生不良反应。完成预定3~4h透析治疗的比例:方案一为75.7%,方案二为98.4%(P<0.01)。将滤器及静脉壶中度以下凝血视为抗凝有效,方案一及方案二的滤器抗凝有效率分别为89.12%、94.57%(P>0.05),而静脉壶抗凝有效率分别为78.3%、90.7%(P<0.05)。方案二患者监测透析前后血气,结果显示透析后离子钙水平与透析前无显著性差异(P>0.05)。结论:简化RCA方案能保证多数患者无肝素透析治疗顺利进行,避免滤器、静脉壶严重凝血及其导致的透析提前中止,特别是方案二,静脉壶凝血的发生率明显下降,并且未发生明显不良反应,对血气结果无明显影响。Objective： To investigate the efficacy and safety of a simplified regional citrate anticoagulation（ SRCA） protocols in heparin-free hemodialysis（ HD）. Methodology： From June 2016 to January 2017, forty two maintenance HD（ MHD） patients in our center received heparin-free HD due to various reasons were enrolled in this study.Among them,13 enrolled in the former term of the study were prescribed to received S-RCA based on protocol 1 and 29 enrolled in the latter term of the study receiving S-RCA based protocol 2. As in protocol 1,at the commence of HD session（ calcium containing dialysis）,15% trisodium citrate（ TSC） was continuously infused into arterial line at the site pre-filter with a speed of 40ml/h; which was the same in protocol 2,except for additional infusion of 15% TSC into venous line at the venous bubble trap with the speed of 10ml/h. No supplement of calcium was given. The severity of filter and line clotting,unplanned ending of HD session were analyzed,as well as possible adverse reactions. Results： Totally,There were 37 sessions of HD in 13 patients using protocol 1 and 129 sessions of HD in 29 patients using protocol 2. No adverse reaction was observed. The percentage of unplanned ending of HD was 24. 3% and 1. 6% in protocol 1 and 2 respectively（ P0. 01）. The efficacy for anticoagulation,which defined as no occurrence of severe clotting was 89. 1% in protocol 1 and94. 6% in protocol 2 for filter（ P〉0. 05）,while was 78. 3% in protocol 1 and 90. 7% in protocol 2 for venous bubble trap（ P〈0. 05）. There was no significant change of serum calcium before and after HD session,as revealed by blood gas analysis pre-and post-HD in protocol 2（ P〉0. 05）. Conclusion： The simplified protocols of RCA,particularly protocol 2,may be effective in heparin-free HD to prevent severe filter and venous trap clotting and guarantee completion of planned HD sessions,without any adverse reaction and impact on serum calcium.

关 键 词：维持性血液透析 凝血 枸橼酸抗凝 

分 类 号：R692.5[医药卫生—泌尿科学]