枸橼酸钠局部抗凝对接受连续性肾脏替代治疗危重症患者抗凝效果及安全性分析  

Anticoagulant effect of local anticoagulation with sodium citrate on continuous renal replacement therapy for critically ill patients and its safety analysis

作　　者：唐林军[1] 陈德勇[1] 陈旭华[1] TANG Linjun;CHEN Deyong;CHEN Xuhua(ICU in Department of Internal Medicine,the People's Hospital of Gaozhou City,Guangdong,Gaozhou 525200,China)

机构地区：[1]高州市人民医院内科ICU,广东高州525200

出　　处：《包头医学院学报》2018年第3期10-12,共3页Journal of Baotou Medical College

基　　金：茂名市科技计划项目(20160330)

摘　　要：目的:探究枸橼酸钠局部抗凝对接受连续性肾脏替代治疗危重症患者的应用效果。方法:选择2015年6月至2017年6月接受连续性肾脏替代治疗的50例危重症患者,随机分为两组,即观察组采用枸橼酸钠局部抗凝,对照组采用普通肝素抗凝。再对比两组i Ca^(2+)、Cl^-、Na^+、Ph值水平等安全性指标、出血情况与抗凝效果、肾功能指标以及血液生化指标。结果:观察组i Ca^(2+)为(2.32±0.34)mmol/L高于对照组(P<0.05),Cl^-为(93.25±8.25)mmol/L低于对照组(P<0.05);观察组出血或原有出血加重情况少于对照组(P<0.05),且凝血0~I级比例低于对照组(P<0.05);观察组尿素氮(BUN)、肌酐(Scr)水平低于对照组(P<0.05);观察组白细胞介素-1β(IL-1β)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)以及一氧化氮(NO)水平均低于对照组(P<0.05)。结论:连续性肾脏替代治疗危重症患者采用枸橼酸钠局部抗凝可有效改善患者出血情况,且抗凝效果良好,提高患者肾功能,安全性较高,值得临床推广采用。Objective:To investigate the application efficacy of local anticoagulation with sodium citrate in the treatment of critically ill patients with continuous renal replacement therapy.Methods:50 critically ill patients who received continuous renal replacement therapy from June 2015 to June 2017 were selected and divided into two groups.The patients in the observation group were treated with local anticoagulation with sodium citrate while patients in the control group were treated with unfractionated heparin anticoagulation.The safety indexes such as iCa 2+,Cl-,Na+,pH levels,blood loss,anticoagulant effects,renal function indexes and blood biochemical indexes were compared between the two groups.Results:In the observation group,iCa2+was(2.32±0.34)mmol/L,which was significantly higher than that of the control group,and Cl-was(93.25±8.25)mmol/L,which was significantly lower than that of the control group(P<0.05).The increase of bleeding or original bleeding in the observation group was significantly less than that in the control group,and the proportion of coagulation 0~I grade was significantly lower than that of the control group(P<0.05).The levels of BUN and Scr in the observation group were significantly lower than those in the control group(P<0.05).The levels of IL-1,IL-8,TNF-and NO in the observation group were significantly lower than those in the control group(P<0.05).Conclusion:Local anticoagulation with sodium citrate can improve the bleeding in critically ill patients with continuous renal replacement therapy and the anticoagulant effect is good.It can improve renal function with high safety,which is worthy of clinical use.

关 键 词：枸橼酸钠局部抗凝 连续性肾脏替代治疗 危重症患者 抗凝效果 

分 类 号：R459.5[医药卫生—治疗学]