枸橼酸钠抗凝在重症血液净化中的抗凝效果和安全性  

Anticoagulant effect and safety of sodium citrate anticoagulant in severe blood purification

作　　者：吴苏华 梁国源 谢如湖 WU Su-hua;LIANG Guo-yuan;XIE Ru-hu(Department of Critical Care Medicine,the Eighth People's Hospital of Dongguan City,Guangdong 523325,Guangdong,CHINA)

机构地区：[1]东莞市第八人民医院重症医学科,广东东莞523325

出　　处：《海南医学》2022年第8期976-979,共4页Hainan Medical Journal

摘　　要：目的探究枸橼酸钠抗凝在重症血液净化中的抗凝效果和安全性。方法选取2019年11月至2020年11月东莞市第八人民医院重症医学科需要进行血液净化的重症患者60例作为研究对象,按照随机数表法分为对照组和研究组各30例。对照组患者采用低分子肝素抗凝治疗,研究组患者则采用枸橼酸钠抗凝治疗。比较两组患者治疗前、治疗两周后的血液生化指标[血液酸碱度(pH)、实际离子钙(iCa^(2+))、血清钠(Na^(+))、碳酸氢根(HCO_(3)^(-))、血清肌酐(Scr)]、凝血功能[血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)]及治疗期间的不良反应发生情况,并评估治疗两周后两组患者的治疗效果。结果研究组患者的临床治疗总有效率为96.67%,明显高于对照组的76.67%,差异有统计学意义(P<0.05);治疗前,两组患者的pH、iCa^(2+)、Na^(+)、HCO_(3)^(-)、Scr水平比较差异均无统计学意义(P>0.05);治疗后,研究组患者的pH、iCa^(2+)、Na^(+)分别为7.38±0.05、1.14±0.15、(140.6±4.5)mmol/L,与对照组的7.40±0.06、1.18±0.12、(141.2±3.8)mmol/L比较差异均无统计学意义(P>0.05);治疗后,两组患者的HCO_(3)^(-)水平较治疗前升高,且研究组水平为(24.02±2.12)mmol/L,明显高于对照组的(19.87±2.78)mmol/L,差异均有统计学意义(P<0.05);治疗后,两组患者的Scr水平较治疗前降低,且研究组水平为(403.72±47.91)mmol/L,明显低于对照组的(487.87±90.78)mmol/L,差异均有统计学意义(P<0.05);治疗前,两组患者的APTT、PT、TT比较差异均无统计学意义(P>0.05);治疗后,研究组患者的APTT、PT、TT分别为(29.09±7.98)s、(11.86±3.41)s、(19.72±3.91)s,明显短于对照组的(38.93±7.49)s、(18.38±3.32)s、(24.47±4.08)s,差异均有统计学意义(P<0.05);研究组患者治疗期间的不良反应发生率为6.67%,明显低于对照组的23.33%,差异有统计学意义(P<0.05)。结论重症血液净化中应用枸橼酸钠的抗凝效Objective To explore the anticoagulation effect and safety of sodium citrate anticoagulation in severe blood purification.Methods Sixty severe patients who needed blood purification in the Department of Critical Medicine,Dongguan Eighth People's Hospital from November 2019 to November 2020 were selected as the research objects.According to the random number table method,they were divided into the control group and the study group,with 30 patients in each group.The patients in the control group were treated with low molecular weight heparin anticoagulation,and the patients in the study group were treated with sodium citrate anticoagulation.The blood biochemical indexes[blood pH,actual ionic calcium(iCa^(2+)),serum sodium(Na^(+)),bicarbonate(HCO_(3)^(-)),serum creatinine(SCR)],coagulation function[plasma prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)]and adverse reactions during treatment of the two groups before and after treatment were compared.The therapeutic effects after two weeks of treatment of the two groups were evaluated.Results The total effective rate of clinical treatment in the study group was 96.67%,which was significantly higher than 76.67%in the control group(P<0.05).Before treatment,there was no significant difference in the levels of pH,iCa^(2+),Na^(+),HCO_(3)^(-),and SCR between the two groups(P>0.05);after treatment,the pH,iCa^(2+),and Na^(+) in the study group were 7.38±0.05,1.14±0.15,(140.6±4.5)mmol/L,which showed no significant difference with 7.40±0.06,1.18±0.12,(141.2±3.8)mmol/L in the control group(P>0.05);after treatment,the level of HCO_(3)^(-) in the two groups was higher than that before treatment,and the level in the study group was(24.02±2.12)mmol/L,which was significantly higher than(19.87±2.78)mmol/L in the control group(P<0.05);after treatment,the level of Scr in the two groups was lower than that before treatment,and the level in the study group was(403.72±47.91)mmol/L,which was significantly lower than(487.87±90.78)mmol/L in the con

关 键 词：血液净化 枸橼酸钠 抗凝 重症 效果 安全性 

分 类 号：R55[医药卫生—血液循环系统疾病]