局部枸橼酸钠和低分子肝素抗凝在危重症患者连续性静脉-静脉血液滤过中的应用比较  

Comparison of application of local sodium citrate and low-molecular-weight heparin anticoagulation in continuous venous-venous hemofiltration of critically ill patients

作　　者：魏世雄 吴佳成 WEI Shi-xiong;WU Jia-cheng(Department of Critical Medicine,Shanwei Second People’s Hospital(Shanwei Yiwei Fund Hospital),Shanwei 516600,China)

机构地区：[1]汕尾市第二人民医院(汕尾逸挥基金医院)重症医学科,516600

出　　处：《中国实用医药》2020年第20期118-120,共3页China Practical Medicine

摘　　要：目的比较局部枸橼酸钠抗凝和低分子肝素抗凝在危重症患者连续性静脉-静脉血液滤过(CVVH)中的效果。方法56例行连续性静脉-静脉血液滤过治疗的危重症患者,根据抗凝治疗药物不同分为观察组和对照组,各28例。对照组采用局部低分子肝素抗凝,观察组采用局部枸橼酸酸钠抗凝。比较两组治疗前、治疗后48 h血肌酐下降率及急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)下降值及滤器使用时间、静脉管路使用时间。结果治疗后48 h,观察组血肌酐下降率为(49.21±10.23)%,高于对照组的(33.11±14.21)%,差异具有统计学意义(P<0.05)。治疗后48 h,观察组APACHEⅡ评分下降值为(5.1±1.1)分,明显高于对照组的(2.3±1.0)分,差异具有统计学意义(P<0.05)。观察组滤器使用时间和静脉管路使用时间分别为(23.22±1.32)、(21.21±1.87)h,均显著长于对照组的(14.23±1.65)、(15.23±1.43)h,差异均有统计学意义(P<0.05)。结论在危重症患者连续性静脉-静脉血液滤过中,采取局部枸橼酸钠抗凝治疗效果确切,可延长滤器与静脉管路使用时间,值得临床推广。Objective To compare the effect of local sodium citrate and low-molecular-weight heparin anticoagulation in continuous venous-venous hemofiltration(CVVH)of critically ill patients.Methods A total of 56 critically ill patients treated by continuous venous-venous hemofiltration were divided into observation group and control group according to the anticoagulants,with 28 cases in each group.The control group received lowmolecular-weight heparin anticoagulation,and the observation group received local sodium citrate anticoagulation.The creatinine reduction rate and Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)before treatment and 48 h after treatment,lifespan of filter and venous pipeline were compared between the two groups.Results 48 h after treatment,creatinine reduction rate of the observation group was(49.21±10.23)%,which was higher than that of the control group(33.11±14.21)%,and the difference was statistically significant(P<0.05).48 h after treatment,APACHEⅡscore dropped(5.1±1.1)points,which was obviously higher than that of the control group(2.3±1.0)points,and the difference was statistically significant(P<0.05).The lifespan of filter and venous pipeline of the observation group were(23.22±1.32)and(21.21±1.87)h,which were significantly longer than those of the control group(14.23±1.65)and(15.23±1.43)h,and the difference was statistically significant(P<0.05).Conclusion In continuous venous-venous hemofiltration of critically ill patients,the effect of local sodium citrate anticoagulation is definite,it can prolong the lifespan of filters and venous pipeline,and it is worth clinical promotion.

关 键 词：枸橼酸钠 低分子肝素 连续性静脉-静脉血液滤过 抗凝治疗 

分 类 号：R459.5[医药卫生—治疗学]