低分子肝素钠与枸橼酸钠对血液透析在高危出血风险患者中的临床对比观察  

Effects of low molecular weight heparin sodium and sodium citrate on hemodialysis patients at high risk of bleeding:a comparative study

作　　者：袁娟 YUAN Juan(Blood Purification Centre,First Affiliated Hospital of Hunan University of Chinese Medicine,Changsha 410007,China)

机构地区：[1]湖南中医药大学第一附属医院血液净化中心,湖南长沙410007

出　　处：《中国输血杂志》2022年第1期39-42,共4页Chinese Journal of Blood Transfusion

摘　　要：目的探讨在接受常规血液透析的高危出血倾向患者中应用枸橼酸透析管路局部抗凝对出凝血指标的影响,评价其安全性。方法选择2018年05月~2020年05月入本院行维持性血液透析伴高危出血倾向患者共96人,随机分为对照组和观察组,每组各48人。对照组采用普通肝素全身抗凝,观察组采用枸橼酸钠体外透析管路局部抗凝。比较2组体内外凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fg)和D-二聚体凝血指标与滤器使用时间以及透析效率的差异。比较2组发生滤器凝血、透析管路凝血及出血发生率,以及代谢性碱中毒、低钙血症等并发症发生率的差异。结果与透析前比较,观察组透析后凝血指标(ACT、PT、Fg、APPT及D-二聚体)无统计学差异(P>0.05),而对照组透析后凝血指标显著延长(P<0.05);透析前2组凝血指标无显著差异(P>0.05),而透析后观察组凝血指标显著较短(P<0.05)。观察组滤器总使用时间(42.6±9.5)h显著长于对照组(36.7±9.8)h(P<0.05),但2组透析效率比较无显著差异(P>0.05)。观察组滤器凝血(0.0%)、透析管路凝血(0.0%)及出血发生率(2.1%)低于对照组(8.3%,6.2%,14.6%)(P<0.05),而2组代谢性碱中毒和低钙血症发生率比较无显著差异(P>0.05)。结论局部枸橼酸体外抗凝对于维持性血液透析伴高危出血倾向患者有较好的安全性,能明显延长滤器使用时间、降低滤器出血率,对体内凝血功能影响小。Objective To compare the therapeutic effects of low molecular weight heparin sodium and sodium citrate on hemodialysis(HD)patients at high risk of bleeding.Method A total of 96 patients at high risk of bleeding on maintenance hemodialysis from May 2018 to May 2020 were enrolled and divided randomly into control group(n=48)and observation group(n=48).Patients in control group received systemic anticoagulation with heparin,and patients in observation group adopted regional citrate anticoagulation of in vitro dialyzer.The indexes of prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fg),D-dimer,service time of filters and the dialysis efficiency,as well as the complication occurrences of clotting events,bleeding,metabolic alkalosis and hypocalcaemia were compared between the two groups.Results No significant difference was found in coagulation indicators(ACT,PT,Fg,APPT and D-dimer)before and after hemodialysis in observation group(P>0.05),but those in control group were prolonged significantly(P<0.05).The service time of filters in observation group(42.6±9.5 h)were longer than that in control group(36.7±9.8 h)(P<0.05),but the dialysis efficiency showed no difference between groups(P>0.05).The incidence of filter clotting(0.0%),dialyzer pipeline clotting(0.0%)and bleeding(2.1%)in observation group were less than those in control group(8.3%,6.2%,14.6%,respectively)(P<0.05),but the incidence of metabolic alkalosis and hypocalcaemia were not significantly different(P>0.05).Conclusion Regional anticoagulation with citric acid in vitro is safe for patients on maintenance hemodialysis at high risk of bleeding,and can greatly prolong service time of filters,reduce bleeding and thrombocytopenia rates,bring less effects to coagulation function in vivo.

关 键 词：枸橼酸钠 局部抗凝 维持性血液透析 高危出血 凝血功能 

分 类 号：R459.5[医药卫生—治疗学] R364.13[医药卫生—临床医学]