肝素封管液与4%枸橼酸钠封管液在危重患者血液净化中的应用  

Application of Heparin Sealing Solution and 4% Sodium Citrate Sealing Solution in Blood Purification of Critically Ill Patients

作　　者：李艳艳[1] 高志明 唐媚 郭丽[1] 钟建[1] LI Yanyan;GAO Zhiming;TANG Mei;GUO Li;ZHONG Jian(Department of Critical Care Medicine,Peking University Shenzhen Hospital,Shenzhen,Guangdong Province,518000 China)

机构地区：[1]北京大学深圳医院重症医学科,广东深圳518000

出　　处：《系统医学》2021年第24期69-71,87,共4页Systems Medicine

摘　　要：目的比较分析肝素封管液与4%枸橼酸钠封管液在危重患者血液净化中的作用。方法选择2019年1月—2020年12月该院ICU治疗且使用临时静脉血液透析导管的危重患者80例,随机分为两组,每组40例。分别应用肝素封管液(肝素组)和4%枸橼酸钠封管液(枸橼酸钠组)进行封管,分别检测患者在血液净化前、净化后4 h的凝血功能,记录两组患者的导管回抽肉眼可见血栓发生率、导管堵塞的发生率、拔管前6 s回抽血量>20 mL的例数、穿刺点周围渗血发生率、导管留置时间以及凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)变化,并进行比较分析。结果两组患者血液净化前凝血功能差异无统计学意义(P>0.05),同一组内血液净化前后PT及APTT对比,枸橼酸钠组的PT及APTT封管前后差异无统计学意义(P>0.05),肝素组血液净化后4 h的PT及APTT较净化前显著延长,差异有统计学意义(t=7.423、8.492,P<0.05)。枸橼酸钠组的导管回抽肉眼可见血栓次数、导管堵塞次数明显高于肝素组,而在拔管前6 s回抽血量>20 mL次数、穿刺口渗血例数以及导管留置时间显著低于肝素组,差异有统计学意义(P<0.05)。结论 4%枸橼酸钠具有局部抗凝作用,相较肝素封管液对患者凝血功能影响更小,更安全。而肝素封管液在危重患者血液净化时临时中心静脉置管封管过程中封管效果较佳。Objective To compare and analyze the effects of heparin sealing solution and 4% sodium citrate sealing solution in blood purification of critically ill patients. Methods From January 2019 to December 2020, 80 critically ill patients who were treated in the hospital’s ICU and used temporary venous hemodialysis catheters were selected. They were randomly divided into two groups, 40 cases in each group, and the tubes were sealed with heparin tube-sealing solution(heparin group) and 4% sodium citrate tube-sealing solution(sodium citrate group). The blood coagulation function of patients before and 4 h after purification were tested respectively. The incidence of macroscopically visible thrombus with catheter withdrawal, the incidence of catheter blockage, the number of cases where the blood withdrawal 6 s before extubation was greater than 20 mL, the incidence of blood oozing around the puncture point, the catheter indwelling time, and prothrombin time(PT), activated partial throm boplastin time(APTT) in the two groups of patients were recorded and compared and analyzed. Results There was no statistically significant difference in coagulation function between the two groups of patients before blood purification(P >0.05). The PT and APTT before and after blood purification in the same group were compared. There was no statistically significant difference in PT and APTT before and after the tube closure in the sodium citrate group(P>0.05). The PT and APTT of the heparin group 4 h after blood purification were significantly longer than before the blood purification, and the difference was statistically significant(t=7.432, 8.492, P<0.05). The number of blood clots and catheter blockages in the sodium citrate group was significantly higher than that in the heparin group.However, the number of cases with blood withdrawal >20 mL 6 s before extubation, and the number of bleeding at the puncture port the catheter indwelling time was significantly lower than that of the heparin group, the difference was statistically signif

关 键 词：肝素 枸橼酸钠 封管液 血液净化 

分 类 号：R473[医药卫生—护理学]