枸橼酸钠抗凝在不同血液净化模式中的应用  

Application of regional citrate anticoagulation in different blood purification modalities

作　　者：潘鑫 谢攀 卓燕 李欢娜 彭侃夫 PAN Xin;XIE Pan;ZHUO Yan;LI Huan-na;PENG Kan-fu(Department of Nephrology,The First Hospital Affiliated to Army Medical University(Southwest Hospital),Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院西南医院肾科,重庆400038

出　　处：《中国血液净化》2020年第8期543-546,共4页Chinese Journal of Blood Purification

基　　金：国家自然科学基金(81370836,81873606)。

摘　　要：抗凝是血液净化能够顺利完成的先决条件。目前临床经典的抗凝方式以肝素、低分子肝素为主,但枸橼酸钠抗凝以其安全、有效、应用范围更广、生物相容性更优的特点,被广泛用于持续血液净化,并得到国内外指南的推荐;在其他不同血液净化模式中,大量的研究也证实枸橼酸钠是1种理想抗凝剂。然而在实践过程中,发现枸橼酸钠抗凝在监测和调整上步骤繁复,存在较多潜在副作用。因此许多学者提出了优化方案并进行了探索和尝试,为枸橼酸钠能够在血液净化中更好发挥抗凝作用提供更多思路。本文就枸橼酸钠在不同血液净化模式中的抗凝方案的监测和调整的进展进行回顾。Anticoagulation is of major importance for successful performance of blood purification.Currently,the classic anticoagulation methods are heparin and low molecular weight heparin.Regional anticoagulation of citrate(RCA)is now widely used for continuous blood purification due to its safety,effectiveness,wider application range and better biocompatibility.RCA has been recommended in domestic and foreign guidelines.Citrate anticoagulation is an ideal method,which has been confirmed by a large number of studies in different blood purification modalities.However,citrate has several drawbacks found in clinical practice,including complicated monitoring and adjustment and many potential side effects.Optimized protocols of citrate anticoagulation are therefore explored and recommended in order to provide new ways for the better use of citrate as an anticoagulation agent in blood purification.In this paper,we review the progress in monitoring and adjusting RCA in different blood purification modalities.

关 键 词：枸橼酸钠抗凝 血液净化 优化方案 

分 类 号：R459.5[医药卫生—治疗学]