枸橼酸钠抗凝在血液净化中的应用效果及对出血的影响  

Application Effect of Anticoagulation of Sodium Citrate in Blood Purification and Its Effect on Bleeding

作　　者：王国青 WANG Guo-qing(Department of Critical Care Medicine,Guanxian Central Hospital,Guanxian,Shandong Province,252500 China)

机构地区：[1]冠县中心医院重症医学科

出　　处：《中外医疗》2019年第30期20-22,25,共4页China & Foreign Medical Treatment

摘　　要：目的对血液净化中应用枸橼酸钠抗凝剂的效果进行探讨。方法方便选择收治连续性血液净化(CBP)患者60例,所有患者均于2018年1—12月在该院接受治疗,按照随机数字表法分为实验组(n=30)和常规组(n=30)。常规组应用肝素抗凝,实验组应用枸橼酸钠局部抗凝,观察两组抗凝效果。结果治疗前实验组APACHEⅡ评分(21.9±4.3)分,和常规组的(22.1±4.5)分对比差异无统计学意义(t=0.18,P=0.43)。治疗后实验组APACHEⅡ评分(10.1±2.8)分,显著低于常规组的(12.2±3.3)分(t=2.67,P=0.01)。治疗前实验组Scr(322.1±91.3)mmol/L、BUN(25.6±9.4)mmol/L、ALT(190.9±32.3)U/L、AST(199.9±32.4)U/L、pH(7.1±0.2),与常规组的(323.9±90.2)mmol/L、(25.5±9.6)mmol/L、(191.7±31.2)U/L、(202.3±32.1)U/L、(7.1±0.1)对比差异无统计学意义(t=0.08,P=0.47;t=0.04,P=0.48;t=0.10,P=0.46;t=0.29,P=0.39;t=0.00,P=0.50)。治疗后实验组Scr(155.1±42.3)mmol/L、BUN(10.2±3.1)mmol/L、ALT(67.9±20.3)U/L、AST(64.9±22.4)U/L,显著低于常规组的(251.2±51.2)mmol/L、(14.2±3.3)mmol/L、(89.2±22.2)U/L、(81.7±20.2)U/L(t=7.93,P=0.00;t=4.84,P=0.00;t=3.88,P=0.00;t=3.05,P=0.00)。治疗后实验组pH(7.4±0.2),与常规组的(7.4±0.1)对比差异无统计学意义(t=0.00,P=0.50)。实验组瘀斑发生率3.3%,与常规组的6.7%对比差异无统计学意义(χ^2=0.35,P=0.55)。实验组出血发生率0.0%、血肿发生率3.3%,均显著低于常规组的13.3%、20.0%(χ^2=4.29,P=0.04;χ^2=4.04,P=0.04)。结论在CBP患者中应用枸橼酸钠局部抗凝效果显著,其能够明显改善患者凝血功能和肝肾功能,并减少出血,具有较高推广价值。Objective To investigate the effect of using sodium citrate anticoagulant in blood purification.Methods Sixty patients with continuous blood purification(CBP)were convenient selected and enrolled.All patients were treated in the hospital from January to December 2018.They were divided into experimental group(n=30)and routine group(n=30)according to the random number table method.The conventional group was treated with heparin anticoagulation.The experimental group was treated with sodium citrate for local anticoagulation,and the anticoagulation effects of the two groups were observed.Results The APACHE II score(21.9±4.3)points of the experimental group before treatment was not significantly different from that of the conventional group(22.1±4.5)points(t=0.18,P=0.43).After treatment,the APACHE II score of the experimental group(10.1±2.8)points was significantly lower than that of the conventional group(12.2±3.3)points(t=2.67,P=0.01).Before treatment,the experimental group Scr(322.1±91.3)mmol/L,BUN(25.6±9.4)mmol/L,ALT(190.9±32.3)U/L,AST(199.9±32.4)U/L,pH(7.1±0.2).Compared with the conventional group(323.9±90.2)mmol/L,(25.5±9.6)mmol/L,(191.7±31.2)U/L,(202.3±32.1)U/L,(7.1±0.1),there is no statistical difference.Academic significance(t=0.08,P=0.47;t=0.04,P=0.48;t=0.10,P=0.46;t=0.29,P=0.39;t=0.00,P=0.50).After treatment,the experimental group Scr(155.1±42.3)mmol/L,BUN(10.2±3.1)mmol/L,ALT(67.9±20.3)U/L,AST(64.9±22.4)U/L,significantly lower than the conventional group(251.2±51.2)mmol/L,(14.2±3.3)mmol/L,(89.2±22.2)U/L,(81.7±20.2)U/L(t=7.93,P=0.00;t=4.84,P=0.00;t=3.88,P=0.00;t=3.05,P=0.00).After treatment,the pH of the experimental group(7.4±0.2)was not significantly different from that of the conventional group(7.4±0.1)(t=0.00,P=0.50).The incidence of ecchymoses in the experimental group was 3.3%,which was not statistically significant compared with the 6.7%in the conventional group(χ^2=0.35,P=0.55).The incidence of bleeding in the experimental group was 0.0%,and the incidence of hematoma was 3.3%

关 键 词：枸橼酸钠 抗凝 血液净化 出血 

分 类 号：R552[医药卫生—血液循环系统疾病]