枸橼酸抗凝对延长高危出血风险患者持续肾脏替代治疗滤器寿命的效果观察  

Application of citrate anticoagulation with continuous renal replacement therapy at high risk of bleeding patients

作　　者：许正红[1] 潘红[2] 黄琴红[2] 曹燕[2] 周皎[2] 王海翔[2] 郭兰[2] Xu Zhenghong Pan Hong Huang Qinhong Cao Yan Zhou Jiao Wang Haixiang Guo Lan(ICU of Wuxi People＇s Hospital, Affiliated Hospital of Nanjing Medical University, Wuxi 214023, China)

机构地区：[1]南京医科大学附属无锡市人民医院护理部,214023 [2]南京医科大学附属无锡市人民医院ICU,214023

出　　处：《中国实用护理杂志》2017年第21期1609-1611,共3页Chinese Journal of Practical Nursing

基　　金：无锡市医院管理中心科研项目（YGZXM1527）

摘　　要：目的 探讨枸橼酸抗凝对延长高危出血风险患者持续肾脏替代治疗滤器寿命的效果.方法 选择2015年1月至2016年10月收治的47例需行持续肾脏替代治疗的高危出血风险患者,按照随机数字表法分为枸橼酸组24例和0.9%氯化钠组23例.枸橼酸组采用枸橼酸体外抗凝,0.9%氯化钠组采用0.9%氯化钠冲洗.观察滤器寿命、出凝血时间、血气等指标变化.结果 枸橼酸组使用滤器76个,0.9%氯化钠组使用滤器87个.枸橼酸组滤器平均寿命为（22.4±12.7）h,0.9%氯化钠组为（8.6±3.3）h,2组比较差异有统计学意义（t=9.79,P＜0.01）;体外循环凝血发生率枸橼酸组为3.9%（3/76）,低于0.9%氯化钠组的16.1%（14/87）,2组比较差异有统计学意义（χ2=-5.20,P＜0.05）.结论 枸橼酸延长滤器寿命,是高危出血风险患者安全、有效的持续肾脏替代治疗抗凝方式.Objective To investigate the efficacy and safety of citrate anticoagulation for continuous renal placement therapy （CRRT） in patients at high risk of bleeding. Methods Forty-seven patients who needed to CRRT and were admitted into the department of critical care medicine from January 2015 to October 2016 were enrolled in this study. According to the patient′s actual condition, they were divided into citrate groups （24 cases） and saline group （23 cases）. Patients in saline group were given saline wash. The efficacy and safety were compared between the two groups. The filter lifetime, after treatment the activated partial thromboplastin time （APTT）, hemoglobin （Hb）, blood gas indexes were compared between the two groups. Results The citrate group used 76 filters while the 0.9% sodium chloride group used 87 filters. The average filter lifetime in citrate group was （22.4 ± 12.7） h which was longer than （8.6±3.3） h in 0.9%sodium chloride group （t=9.79, P〈0.01）. The incidence of coagulation in extracorporeal circulation was 3.9%（3/76） which was lower than 16.1%（14/87） in 0.9%sodium chloride group（χ2=5.20, P〈0.05）. Conclusions Regional citrate anticoagulation is a safe and effective option for CRRT in patients at high risk of bleeding.

关 键 词：枸橼酸抗凝 肾替代治疗 高危出血风险 

分 类 号：R473.5[医药卫生—护理学]