枸橼酸抗凝与无抗凝模式的持续静脉-静脉血液滤过治疗颅内出血伴肾功能不全患者的安全性及对预后的影响  

Safety of continuous veno-venous hemofiltration with or without citrate anticoagulation in patients with intracranial hemorrhage and renal insufficiency and its influence on prognosis

作　　者：区玉铭 梁庆标[1] 廖建军[1] QU Yuming;LIANG Qingbiao;LIAO Jianjun(Huangpu People's Hospital of Zhongshan,Zhongshan 528429,China)

机构地区：[1]中山市黄圃人民医院,广东中山528429

出　　处：《临床医学研究与实践》2021年第29期80-82,共3页Clinical Research and Practice

摘　　要：目的观察枸橼酸抗凝与无抗凝模式的持续静脉-静脉血液滤过(CVVH)治疗颅内出血伴肾功能不全患者的安全性及对预后的影响。方法将2019年1月至2020年12月我院收治的60例颅内出血伴肾功能不全患者根据是否使用枸橼酸抗凝分为抗凝组和无抗凝组,每组30例。两组患者均采用CVVH治疗。比较两组首个过滤器使用寿命,治疗前、治疗后12 h的凝血功能指标和游离钙离子(iCa)水平,治疗7 d的预后情况。结果抗凝组的首个过滤器使用寿命长于无抗凝组(P<0.05)。治疗后12 h,无抗凝组的FIB水平和PLT低于治疗前(P<0.05);抗凝组的ACT长于治疗前,iCa水平低于治疗前(P<0.05);治疗后12 h,抗凝组的iCa水平低于无抗凝组(P<0.05)。枸橼酸抗凝CVVH治疗相较于无抗凝模式可降低患者的病死率(HR=0.196,95%CI 0.099~0.427,P=0.006)。结论CVVH治疗颅内出血伴肾功能不全患者中,行枸橼酸抗凝对患者的凝血功能影响较低,且可以明显降低病死率,安全性较高。Objective To observe the safety of continuous veno-venous hemofiltration(CVVH)with or without citrate anticoagulation in the treatment of intracranial hemorrhage with renal insufficiency and its influence on prognosis.Methods A total of 60 patients with intracranial hemorrhage with renal insufficiency treated in our hospital from January 2019 to December 2020 were divided into anticoagulation group and non-anticoagulation group according to whether citrate anticoagulation was used,with 30 cases in each group.Both groups were treated with CVVH.The service life of the first filter,coagulation function indexes and free calcium ion(iCa)level before treatment and at 12 h after treatment,and the prognosis of 7 d after treatment were compared between the two groups.Results The service life of the first filter in the anticoagulation group was longer than that in the non-anticoagulation group(P<0.05).At 12 h after treatment,FIB level and PLT in the non-anticoagulation group were lower than those before treatment(P<0.05);the ACT of the anticoagulation group was longer than that before treatment,and the level of iCa was lower than that before treatment(P<0.05);at 12 h after treatment,the level of iCa in the anticoagulation group was lower than that in the non-anticoagulation group(P<0.05).CVVH with citrate anticoagulation could reduce the mortality compared with CVVH without citrate anticoagulation(HR=0.196,95%CI 0.099-0.427,P=0.006).Conclusion In the treatment of intracranial hemorrhage with renal insufficiency with CVVH,citrate anticoagulation has low effect on coagulation function of patients,and can significantly reduce the mortality with high safety.

关 键 词：枸橼酸抗凝 无抗凝模式 持续静脉-静脉血液滤过 颅内出血 肾功能不全 预后 

分 类 号：R459.7[医药卫生—急诊医学]