不同抗凝方案连续性血液净化对ICU脓毒血症患者肾功能的保护作用对比  

Comparison of protective effects of continuous blood purification with different anticoagulation schemes on renal function of sepsis patients in ICU

作　　者：许文鹏 郭斌斌 刘庭文 潘洁 李小勇 XU Wenpeng;GUO Binbin;LIU Tingwen;PAN Jie;LI Xiaoyong(Department of Intensive Care,Nanchang Third Hospital,Nanchang,Jiangxi,330009,China;Jiangxi Health Vocational College,Nanchang,Jiangxi,330009,China;Department of Emergency,Nanchang Third Hospital,Nanchang,Jiangxi,330009,China)

机构地区：[1]南昌市第三医院重症科,江西南昌330009 [2]江西卫生职业学院,江西南昌330009 [3]南昌市第三医院急诊科,江西南昌330009

出　　处：《当代医学》2022年第19期111-114,共4页Contemporary Medicine

摘　　要：目的 对比不同抗凝方案连续性血液净化对重症监护病房(ICU)脓毒血症患者肾功能的保护作用。方法 选取2017年1月至2019年11月于本院行连续血液净化治疗的60例ICU脓毒血症患者作为研究对象,根据随机数字表法分为两组,各30例。观察组给予无肝素抗凝治疗,对照组给予低分子量肝素抗凝治疗。比较两组凝血功能、肾功能及预后情况。结果 治疗8 d,两组血小板计数、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及凝血酶时间(TT)均低于治疗前,差异有统计学意义(P<0.05);治疗8 d,两组血小板计数、PT、APTT及TT比较差异无统计学意义;治疗8 d,两组尿素氮、血肌酐水平均低于治疗前,差异有统计学意义(P<0.05);治疗8 d,两组尿素氮、血肌酐水平比较差异无统计学意义;随访1个月结束时,两组急性生理学和慢性健康评估系统Ⅱ(APACHEⅡ)评分均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。结论 无肝素连续血液净化改善ICU脓毒血症患者肾功能及凝血功能的作用与低分子量肝素抗凝治疗相似,但临床应根据患者的实际情况选择更为合适抗凝方案,对于高危出血患者或活动性出血患者采用无肝素抗凝方式可更有效改善患者预后。Objective To compare the protective effects of continuous blood purification with different anticoagulation schemes on renal function of sepsis patients in intensive care unit(ICU). Methods 60 patients with sepsis in ICU who underwent continuous blood purification treatment in our hospital from January 2017 to November 2019 were selected as the research subjects, and they were divided into two groups according to the random number table method, with 30 cases in each group. The observation group was given anticoagulant therapy without heparin, while the control group was given anticoagulant therapy with low molecular weight heparin for 8 d. The coagulation function, renal function and prognosis were compared between the two groups. Results After 8 d of treatment, the platelet count, prothrombin time(PT), activated partial thromboplastin time(APTT)and thrombin time(TT) of the two groups were all lower than those before treatment, and the difference was statistically significant(P<0.05). After 8d of treatment, there was no significant difference in platelet count, PT, APTT and TT between the two groups. After 8 d of treatment, the levels of urea nitrogen and serum creatinine in both groups were lower than those before treatment, and the difference was statistically significant(P<0.05). After 8d of treatment, there was no significant difference in blood urea nitrogen and creatinine levels between the two groups. At the end of one month’ s follow-up, the scores of acute physiology and chronic health evaluation system Ⅱ(APACHEⅡ) in the two groups were lower than those before treatment, and the observation group was lower than the control group, the difference was statistically significant(P<0.05). Conclusion The effect of heparin-free continuous blood purification on improving renal function and coagulation function of ICU sepsis patients is similar to that of low molecular weight heparin anticoagulation therapy, but a more appropriate anticoagulation scheme should be selected clinically according to the actual s

关 键 词：脓毒血症 凝血功能 无肝素抗凝 连续血液净化 

分 类 号：R459.7[医药卫生—急诊医学]