枸橼酸抗凝在脓毒症合并肝功能不全患者持续肾脏替代治疗期间的安全性及有效性研究  

Safety and efficacy of citrate anticoagulation for septic patients with liver patients

作　　者：曹燕[2] 钱丹[1] 潘红[2] 庄朋 张鑫 Cao Yan;Qian Dan;Pan Hong;Zhuang Peng;Zhang Xin(Intensive Care Unit of Wuxi People′s Hospital,Wuxi 214023,China;Nursing Department of Wuxi People′s Hospital,Wuxi 214023,China)

机构地区：[1]江苏省无锡市人民医院重症医学科,214023 [2]江苏省无锡市人民医院护理部,214023

出　　处：《中国实用护理杂志》2019年第32期2488-2491,共4页Chinese Journal of Practical Nursing

摘　　要：目的探讨合并肝功能不全的脓毒症患者枸橼酸抗凝在持续肾脏替代治疗中的应用效果.方法回顾性分析江苏省无锡市人民医院重症医学科2016年1月至2017年12月收治的行血液滤过的脓毒症患者临床资料.肝功能评分>4分诊断为肝功能不全,共56例患者符合此标准.其中29例患者使用枸橼酸局部抗凝(枸橼酸组),27例患者使用低分子肝素抗凝(低分子肝素组).观察血气分析、滤器寿命、血气指标和肌酐等指标变化.结果枸橼酸组滤器的寿命为(25.0±12.2)h,低分子肝素组为(13.7±4.5)h,2组比较差异有统计学意义(t=13.172,P<0.01);枸橼酸组每例患者管路使用数量为(4.2±1.9)副,低于低分子肝素组的(8.7±3.6)副,差异有统计学意义(t=8.395,P<0.05);枸橼酸组抗凝效果优于低分子肝素组(χ^2=18.809,P<0.05).治疗后pH值、HCO3^-、滤器后Ca^2+、外周血Ca^2+、活化部分凝血时间、血红蛋白和肌酐方面比较差异无统计学意义(P>0.05).结论对于肝功能不全的脓毒症患者,局部枸橼酸抗凝延长滤器寿命,未引起电解质和内环境紊乱,安全且有效.Objective To evaluate the efficacy and safety of citrate anticoagulation for continuous renal placement therapy(CRRT)in septic patients with liver dysfunction.Methods The data of septic patients who needed to CRRT and were admitted into the department of critical care medicine from January 2016 to December 2017 were enrolled in this study.Liver dysfunction was defined as Child-Turotte-Pugh(CTP)score>4.A total of fifty-six patients met the criteria.According to the patient′s actual condition,they were divided into citrate groups(29 cases)and low molecular weight heparin(LMWH)group(29 cases).Patients in LMWH group were given slow molecular weight heparin.The efficacy and safety were compared between the two groups.The filter lifetime,after treatment the activated partial thromboplastin time(APTT),hemoglobin(Hb)were compared between the two groups.Results The average filter lifetime in citrate group was(25.0±12.2)h which was longer than(13.7±4.5)h in LMWH group(t=13.17,P<0.01).The average service life of each filter was(4.2±1.9)h which was lower than(8.7±3.6)in LMWH group(t=8.395,P<0.05).Conclusions Regional Citrate anticoagulation is a safe and effective option for CRRT in septic patients with liver dysfunction,without causing electrolyte disturbance and internal environment.

关 键 词：枸橼酸抗凝 肝功能不全 脓毒症 

分 类 号：R54[医药卫生—心血管疾病]