局部枸橼酸抗凝与全身肝素化抗凝在脓毒症急性肾损伤患者连续性肾脏替代治疗的疗效分析  

Analysis on curative effects of regional citrate anticoagulation and systemic heparin anticoagulant in continuous renal replacement therapy for patients with acute renal injury in sepsis

作　　者：温振杰 刘建凌 李杰敏 杨惠钊 WEN Zhenjie;LIU Jianling;LI Jiemin;YANG Huizhao(ICU,the Sixth Hospital Affiliated to Guangzhou Medical University(Qingyuan People’s Hospital),Guangdong,Qingyuan 511500,China)

机构地区：[1]广州医科大学附属第六医院(清远市人民医院)ICU

出　　处：《中国医药科学》2020年第1期74-77,共4页China Medicine And Pharmacy

摘　　要：目的探讨局部枸橼酸抗凝与全身肝素化抗凝在脓毒症急性肾损伤患者连续性肾脏替代治疗(CRRT)的效果情况。方法分析我院2017年1月~2018年12月收治的100例脓毒症急性肾损伤患者临床资料,根据随机纸片法进行分组,局部枸橼酸抗凝组50例和全身肝素化抗凝组50例。结果两组脓毒症急性肾损伤患者治疗前PT、APTT、PLT、Cr、BUN、CK-MB、IL-6、乳酸比较,差异均无统计学意义(P>0.05),治疗后两组患者PT、APTT均高于同组治疗前,局部枸橼酸抗凝组PT、APTT均低于全身肝素化抗凝组,PLT、Cr、BUN、CK-MB、IL-6、乳酸均低于同组治疗前,局部枸橼酸抗凝组PLT、滤器使用时间高于全身肝素化抗凝组,Cr、BUN、CK-MB、IL-6、乳酸、不良反应发生率均低于全身肝素化抗凝组,差异有统计学意义(P<0.05)。结论脓毒症急性肾损伤患者CRRT中,局部枸橼酸抗凝效果优于全身肝素化抗凝,改善肾功能更加明显,延长了滤器使用时间,不良反应少。Objective To explore curative effects of regional citrate anticoagulation and systemic heparin anticoagulant in continuous renal replacement therapy for patients with acute renal injury in sepsis.Methods Clinical data of 100 patients with acute renal injury in sepsis who were admitted and treated in our hospital from January 2017 to December 2018 were analyzed.According to the random paper method,they were divided into the regional citrate anticoagulation group and systemic heparin anticoagulant group,with 50 cases in each group.Results There was no statistically significant differences in PT,APTT,PLT,Cr,BUN,CK-MB,IL-6 and lactic acid of patients with acute renal injury in sepsis between the two groups(P>0.05).After treatment,the PT and APTT of the two groups were higher than those of the same group before treatment.PT and APTT of the regional citrate anticoagulation group were lower than those of the systemic heparin anticoagulant group.PLT,Cr,BUN,CK-MB,IL-6 and lactic acid of the regional citrate anticoagulation group after treatment were lower than those before treatment.PLT and filter use time of the regional citrate anticoagulation group were higher than those of the systemic heparin anticoagulant group.Cr,BUN,CK-MB,IL-6,lactic acid and the incidence of adverse reactions in the regional citrate anticoagulation group were all lower than those in the systemic heparin anticoagulant group.The differences were statistically significant(P<0.05).Conclusion In CRRT for patients with acute renal injury in sepsis,the curative effects of regional citrate anticoagulation are better than those of systemic heparin anticoagulant.It can significantly improve kidney function,extensions filter using time and it has fewer adverse reactions.

关 键 词：局部枸橼酸抗凝 全身肝素化抗凝 脓毒症 急性肾损伤 连续性肾脏替代治疗 

分 类 号：R459.7[医药卫生—急诊医学] R692.5[医药卫生—治疗学]