血液透析过程中局部枸橼酸钠抗凝和普通肝素抗凝的临床随机对照研究  

Clinical randomized controlled study on regional sodium citrate and ordinary heparin anticoagulation during hemodialysis

作　　者：赵筱娟 李红莉[1] 安文军[1] ZHAO Xiao-juan;LI Hong-li;AN Wen-jun(Department of Nephrology, Yan＇an People＇s Hospital, Yan＇an 716000, China)

机构地区：[1]延安市人民医院肾内科,陕西延安716000

出　　处：《实用药物与临床》2018年第3期279-282,共4页Practical Pharmacy and Clinical Remedies

摘　　要：目的比较血液透析过程中,局部枸橼酸钠抗凝(RCA)和普通肝素抗凝的有效性和安全性。方法 44例尿毒症长期透析的患者,随机分为RCA组与普通肝素抗凝组(对照组),每组22例,检测各组透析开始时与透析刚刚结束后的体内、体外APTT时间,体内血清游离钙、血钠、碳酸氢根浓度,以及体外循环凝血情况。结果透析开始时与透析刚刚结束后,RCA组体内APTT时间明显缩短(P<0.05),但在正常范围内,差异有统计学意义;而两组体外APTT时间差异无统计学意义(P>0.05)。透析开始及透析刚刚结束,RCA组患者体外检测的游离钙浓度均明显低于体内水平,也明显低于对照组的体内与体外的游离钙检测结果 ,差异有统计学意义(P<0.05)。透析开始与结束时,两组患者体内Na^+、K^+、C1^-水平比较差异无统计学意义(P>0.05);Scr在浓度透析结束时比透析开始时显著下降(P<0.01);RCA组HCO_3^-指标在透析结束后比透析开始时浓度升高(P<0.05),但均在正常范围内。两组患者透析器凝血比例与严重程度相似(P>0.05),均无透析器严重凝血情况发生。结论局部枸橼酸抗凝对体内凝血系统与电解质水平无影响,疗效可靠,适合用于高危出血倾向患者的透析治疗。Objective To observe the efficacy and safety of regional citrate anticoagulation（RCA） and ordinary heparin anticoagulant during hemodialysis.Methods Totally 44 uremia patients endured long-term hemodialysis were randomly divided into RCA group and anticoagulant group of ordinary heparin（control group）,22 cases in each group.The APTT time,serum free calcium,blood sodium,bicarbonate concentration and clotting of the extracorporeal circulation of the patients at the beginning and the end of dialysis in vitro and in vivo were detected.Results Compared with control group,the APTT time of RCA group in vivo was significantly shortened at the beginning and the end of dialysis（P 〈 0.05）,which was within the normal range;there was no significant difference in the APTT time between the two groups in vitro;the concentration of free calcium in RCA group in vitro was significantly lower than that in vivo,which was lower than that of control group during the dialysis（P 〈 0.05）;there was no significant difference in the levels of Na ＋,K ＋ and Cl- between the two groups（P 〉 0.05）.At the end of dialysis,the concent ration of Scr at the end of dialysis was decreased（P 〈 0.01）,while the concentration of HCO3- was increased significantly（P 〈0.05）,which was within the normal range.There was no significant difference in the proportion and severity of blood clotting in dialyzer between the two groups（P 〉 0.05）,and no serious coagulation was found in all the dialyzer.Conclusion The regional sodium citrate anticoagulation hemodialysis is safe and effective,which deserves to be widely applied in patients with high risk of bleeding.

关 键 词：血液透析 局部抗凝 枸橼酸钠 普通肝素 

分 类 号：R692.5[医药卫生—泌尿科学]