局部枸橼酸抗凝在高龄高危出血风险患者血液透析的临床观察  

The Clinical Observation of Local Citric Acid Anticoagulation on Hemodialysis in the Elderly Patientsat High Risk of Bleeding

作　　者：贾慧 李缨 金惠良 JIA Hui;LI Ying;JIN Hiu-liang(Department of Nephrology,Jiading District Central Hospital Affiliated,Shanghai University of Medicine&Health Sciences,Shanghai,201800,China)

机构地区：[1]上海健康医学院附属嘉定区中心医院肾脏内科,上海201800

出　　处：《血栓与止血学》2020年第4期549-552,共4页Chinese Journal of Thrombosis and Hemostasis

摘　　要：目的探讨局部枸橼酸抗凝(RCA)在高龄高危出血风险的血液透析(HD)患者中应用的临床观察。方法选取自2018年1月至2020年1月本院血透室具有高危出血风险的老年患者25例为研究组,给予4%枸橼酸钠局部抗凝进行血液透析治疗,对照组25例高龄患者予小剂量低相对分子质量肝素(LMWH)血液透析,比较两组患者透析前后血压,心率,激活全血凝固时间(ACT)的变化,透析期间出血情况及记录患者有无抽搐、痉挛、唇周、四肢麻木等不良反应;观察透析期间透析器和静脉壶凝血情况;并检测两组透析前后血钠、血钾、总钙、游离钙、二氧化碳结合力、血肌酐(SCr)、尿素氮(BUN),血磷。结果RCA研究组和对照组患者在透析前后血压,心率无显著差异,RCA研究组和对照组透析后ACT比较有显著差异(P<0.05)。RCA研究组透析器和静脉壶0~1级占比显著高于对照组,3级占比显著低于对照组。RCA组患者和对照组患者在透析前后血钾,CO2-CP变化有显著差异,两组之间比较无显著差异。RCA组较对照组透析前后BUN,Scr下降有显著意义,与同期对照组比较有显著意义。结论局部枸橼酸抗凝对高龄高危出血风险的HD患者疗效显著。Objective To investigate the clinical application of local citrate anticoagulation(RCA)in hemodialysis(HD)patients with high risk of bleeding in the elderly.Methods From January 2018 to January 2020,25 elderly patients with high risk of bleeding in the hemodialysis center of our hospital were selected as the study group,who were given 4%sodium citrate local anticoagulation for hemodialysis,and 25 elderly patients in the control group were given low-dose low molecular weight heparin(LMWH)hemodialysis.The changes of blood pressure,heart rate,activ-ated whole blood coagulation time(ACT)and bleeding situation during dialysis were compared before and after dialysis and record whether the patient has side effects such as convulsion,spasm,perilabial numbness and limb numbness.To observe the coagulation of dialyzer and jug during dialysis.The serum sodium,potassium,total calcium,free calcium,carbon dioxide binding capacity,serum creatinine(SCR),urea nitrogen(BUN)and blood phosphorus were measured before and after hemodialysis.Results There was no significant difference in blood pressure and heart rate between the RCA study group and the control group before and after dialysis.There was significant difference in act between the study group and the control group after dialysis(P<0.05)。The proportion of dialyzer and venous jug in the RCA study group was significantly higher than that in the control group,and that in the RCA study group was significantly lower than that in the control group.There was significant difference in the changes of blood potassium and co2-cp between RCA group and control group before and after dialysis,but there was no significant difference between the two groups.Compared with the control group,BUN and SCR in RCA group decreased significantly before and after dialysis,and compared with the control group in the same period.Conclusion Local anticoagulation with citric acid has a significant effect on HD patients at high risk of bleeding in the elderly.

关 键 词：局部枸橼酸抗凝 高危出血 血液透析 高龄 

分 类 号：R459.5[医药卫生—治疗学]