两段式枸橼酸抗凝在普通血液透析的效果  

Observation of the effect of two⁃stage citrate anticoagulation in hemodialysis

作　　者：阳柳[1] 吴欣[1] 李晓颖[1] 刘畅[1] 芶碧珍 YANG Liu;WU Xin;LI Xiaoying;LIU Chang;GOU Bizhen(Department of Kidney Medicine of Guiyang First People′s Hospital,Guiyang 550002,China)

机构地区：[1]贵阳市第一人民医院,贵阳550002

出　　处：《实用医学杂志》2020年第23期3260-3263,3268,共5页The Journal of Practical Medicine

基　　金：贵阳市卫生和计划生育委员会科学技术计划项目(编号:2018筑卫计科技合同字第003号);2017年贵阳市临床重点学科(专科)建设项目;贵阳市科技计划项目(编号:筑科合同[2019]9⁃8号)。

摘　　要：目的观察无肝素、一段式及两段式枸橼酸抗凝在使用含钙透析液的普通血液透析中的抗凝效果及安全性。方法将合并高危出血风险的血液透析患者随机分为三组,分别为无肝素组(N⁃HEP组)、一段式枸橼酸抗凝组(S⁃RCA组)、两段式枸橼酸抗凝组(TS⁃RCA组),共完成66例次治疗。N⁃HEP组,生理盐水冲洗管路;S⁃RCA组在透析器前泵入4%枸橼酸钠;TS⁃RCA组在透析器前及静脉壶处泵入4%枸橼酸钠。观察三组的血液透析治疗时间、抗凝有效率及安全性。结果S⁃RCA组及TS⁃RCA组治疗时间均长于N⁃HEP组(P<0.05);在血液透析器处三组的抗凝有效率,差异无统计学意义(P>0.05);在静脉壶处,S⁃RCA组及TS⁃RCA组抗凝有效率均高于无肝素组(P<0.05),S⁃RCA组与TS⁃RCA组,差异无统计学意义(P>0.05);S⁃RCA组及TS⁃RCA组血液透析治疗后血游离钙均较透析前下降(P<0.05)。结论对于高危出血风险的血液透析患者,枸橼酸抗凝优于无肝素抗凝,且安全有效。Objective To investigate the anticoagulation effect and safety of heparin⁃free,one⁃stage and two⁃stage citrate anticoagulation during hemodialysis with calcium⁃containing dialysate.Methods Hemodialysis patients with high risk of bleeding were randomly divided into three groups:heparin⁃free group(N⁃HEP group),one⁃stage anticoagulant group(S⁃RCA group),and two⁃stage anticoagulant citrate group(TS⁃RCA group),with a total of 66 cases to complete the hemodialysis.The N⁃HEP groups were treated with normal saline flush pipeline,the S⁃RCA group with 4%citrate anticoagulants pumped in the front of the dialyzer and the TS⁃RCA group with 4%citrate anticoagulants pumped in the front of the dialyzer and at the venous pot as well.The three groups were compared in terms of the hemodialysis treatment time,anticoagulant efficiency and safety.Results The treatment time of the S⁃RCA group and the TS⁃RCA group was both significantly longer than that of the N⁃HEP group(P<0.05).There was no significant difference in anticoagulant efficiency among the three groups at the hemodialysis filter(P>0.05).The anticoagulation efficiency of the S⁃RCA group and the TS⁃RCA group was significantly higher than that of the heparin⁃free group(P<0.05),while the difference between the S⁃RCA group and TS⁃RCA group was not statistically significant(P>0.05).After hemodialysis,serum free calcium in both the S⁃RCA group and TS⁃RCA group significantly decreased compared with that before hemodialysis(P<0.05).Conclusions For hemodialysis patients with high risk of bleeding,anticoagulation with citrate is superior to anticoagulation without heparin.It is safe and effective.

关 键 词：枸橼酸 抗凝 血液透析 

分 类 号：R459.5[医药卫生—治疗学]