枸橼酸盐两段式抗凝对维持性血液透析患者的临床效果研究  

Clinical Effect of Citrate two-stage Anticoagulation on Maintenance Hemodialysis Patients

作　　者：冯瑛华 FENG Yinghua(Blood Purification Center,Heshan People's Hospital,Jiangmen,Guangdong Province,529700 China)

机构地区：[1]鹤山市人民医院血液净化中心,广东江门529700

出　　处：《中外医疗》2022年第15期10-14,共5页China & Foreign Medical Treatment

基　　金：枸橼酸盐两段式抗凝对维持性血液透析患者的临床效果研究(20A183)。

摘　　要：目的 对两段式局部枸橼酸抗凝对血液透析患者的临床治疗有效性和安全性进行探讨。方法 方便选取2020年4月—2021年6月该院收治的维持性血液透析患者32例为研究对象,按照不同的抗凝方案将研究对象分为观察组和对照组,各16例,对照组患者给予枸橼酸盐一段式抗凝,观察组患者给予枸橼酸盐两段式抗凝。评估和记录透析前后及透析过程中的临床症状改善情况及实验室数据并进行统计分析。结果 两组患者的血小板计数、凝血酶原时间、活化部分凝血活酶时间和纤维蛋白原比较差异无统计学意义(P>0.05)。对照组的透析器前和静脉壶抗凝有效率分别为97.33%和96.88%,而观察组均为100.00%,差异有统计学意义(χ^(2)=7.292、4.202,P<0.05),实际血流量对照组为(200.97±10.93)mL/min,观察组实际血流量为(229.83±9.29)mL/min,差异有统计学意义(t=8.283,P<0.05),对照组单次透析Kt/V为(0.99±0.23),观察组单次透析Kt/V为(1.83±0.32),差异有统计学意义(t=9.292,P<0.05),对照组4%枸橼酸溶液输注量为(226.44±14.99)mL/h,观察组4%枸橼酸溶液输注量为(200.39±11.66)mL/h,差异有统计学意义(t=3.403,P<0.05);两组患者在透析过程中均未出现严重不良反应,如血压下降和心律失常。对照组有1例患者由于枸橼酸盐增加剂量出现轻微口中麻木情况,但降低枸橼酸盐注射速度后缓解。观察组患者无肌肉抽搐和口角、口中麻木等不良反应发生。结论 枸橼酸盐两段式抗凝与传统的一段式抗凝相比较,在维持性血液透析治疗中是安全的,对临床不适症状有改善作用,且更为有效,有利于改善预后,同时枸橼酸盐两段式抗凝治疗能够促进临床治疗效果的改进,且有助于减少患者经济负担和社会负担,值得推广应用。Objective To investigate the clinical efficacy and safety of two-stage local citrate anticoagulation in patients with hemodialysis.Methods Conveniently selected 32 maintenance hemodialysis patients admitted to the hospital from April 2020 to June 2021 as the research subjects,and divided the research subjects into the observation group and the control group according to different anticoagulation regimens,16 cases in each,and the control group patients were given One-stage citrate anticoagulation was administered,and the patients in the observation group were given two-stage citrate anticoagulation.The improvement of clinical symptoms and laboratory data before and after dialysis and during dialysis were evaluated and recorded for statistical analysis.Results There was no statistically significant difference in platelet count,prothrombin time,activated partial thromboplastin time and fibrinogen between the two groups(P>0.05).The pre-dialyzer and venous pot anticoagulation rates in the control group were97.33% and 96.88%,respectively.While the observation group was 100%,the difference was statistically significant(t=5.733,P<0.05),the actual blood flow in the control group was(200.97±10.93) mL/min.The actual blood flow in the observation group was(229.83±9.29) m L/min,the difference was statistically significant(t=8.283,P<0.05).A single dialysis Kt/V in the control group was(0.99±0.23),a single dialysis Kt/V in the observation group was(1.83±0.32),the difference was statistically significant(t=9.292,P<0.05).The infusion volume of 4% citric acid solution in the control group was(226.44±14.99) m L/h,and the infusion volume of 4% citric acid solution in the observation group was(200.39±11.66) mL/h,the difference was statistically significant(t=3.403,P<0.05).No serious adverse reactions,such as blood pressure drop and arrhythmia,occurred during dialysis in both groups.In the control group,1 patient had slight numbness in the mouth due to the increased dose of citrate,but it was relieved by reducing the speed of ci

关 键 词：枸橼酸抗凝 两段式 血液透析 安全性 

分 类 号：R4[医药卫生—临床医学]