局部枸橼酸抗凝在DPMAS联合低置换量血浆置换治疗慢加急性肝衰竭患者中的应用  

Application of Regional Citrate Anticoagulation in Patients with Acute on Chronic Liver Failure Treated by DPMAS Combined with Low Plasma Exchange

作　　者：王临旭 刘浩 党肖 郑桂华 连建奇 WANG Lin-xu;LIU Hao;DANG Xiao;ZHENG Gui-hua;LIAN Jian-qi(The Second Affiliated Hospital of Air Force Military Medical University,Department of Infectious Diseases,Xi'an,Shaanxi,710038,China;The First Affiliated Hospital of Air Force Military Medical University,Emergency Department,Xi'an,Shaanxi,710038,China)

机构地区：[1]空军军医大学第二附属医院感染科,陕西西安710038 [2]空军军医大学第一附属医院急诊科,陕西西安710038

出　　处：《现代生物医学进展》2021年第14期2748-2752,2800,共6页Progress in Modern Biomedicine

基　　金：国家卫生计生委医药卫生科技发展研究中心研究项目(W2014HB013);陕西省自然科学基金项目(2014JM2-8151)。

摘　　要：目的:探讨采用局部枸橼酸抗凝(RCA)在双重血浆分子吸附系统(DPMAS)联合低置换量血浆置换(LPE)治疗慢加急性肝衰竭患者中的安全性及可行性。方法:收集2019年12月至2020年10月空军军医大学唐都医院感染科收治的10例慢加急性肝衰竭患者使用RCA行DPMAS联合LPE的临床资料,回顾性分析RCA的抗凝效果、不良反应等。结果:成功完成10例次治疗,治疗结束体外循环管路内无凝血块形成,RCA可延长体外循环管路使用时间。治疗前后患者未出现代谢性酸碱紊乱。有2例患者治疗结束时血清总钙(total calcium,Catot)/离子钙(ionized calcium,Caion)≥2.5判定为枸橼酸蓄积,24小时后恢复正常。在治疗中、治疗结束后患者无新发或再发出血现象。结论:肝衰竭患者存在一定程度的代谢枸橼酸的能力,且RCA在人工肝治疗过程中有助于延长体外循环管路的使用时间,同时降低患者出血风险。在严密监测的情况下运用RCA行DPMAS联合低置换量血浆置换治疗慢加急性肝衰竭患者具有一定安全性及可行性。Objective: To investigate the safety and feasibility of using local citrate anticoagulation(RCA) in the treatment of patients with chronic acute liver failure with dual plasma molecular adsorption system(DPMAS) combined with low exchange plasma exchange(LPE). Methods: The clinical data of 10 patients with chronic acute liver failure admitted to the Department of Infectious Diseases, Tangdu Hospital, Air Force Military Medical University from December 2019 to October 2020 were collected and used RCA for DPMAS combined with LPE to retrospectively analyze the anticoagulant effects and adverse reactions of RCA Wait. Results: 10 treatments were successfully completed. At the end of the treatment, there was no clot formation in the extracorporeal circulation circuit.RCA can extend the use time of the extracorporeal circulation circuit. The patient did not have metabolic acid-base disorders before and after treatment. At the end of the treatment, 2 patients had serum total calcium(Catot)/ionized calcium(ionized calcium, Caion) ≥ 2.5 as citrate accumulation, which returned to normal after 24 hours. During and after the treatment, the patient had no new or recurring blood.Conclusion: Patients with liver failure have the ability to metabolize citric acid to a certain extent, and RCA can help prolong the use time of extracorporeal circulation circuit during artificial liver treatment, and reduce the risk of bleeding in patients. Under the condition of close monitoring, the use of RCA to perform DPMAS combined with low-volume exchange plasma exchange in the treatment of patients with chronic onset acute liver failure has certain safety and feasibility.

关 键 词：局部枸橼酸抗凝 慢加急性肝衰竭 DPMAS 低置换量血浆置换 

分 类 号：R575.3[医药卫生—消化系统] R457[医药卫生—内科学]