低钙与标准钙透析液分段枸橼酸抗凝血液透析的使用效果分析  

Analysis of the Effect of Using Low Calcium Dialysate and Standard Calcium Dialysate in Segmented Citrate Anticoagulant Hemodialysis

作　　者：张茜 常阿英 杨正纯 刘丽茹 Zhang Qian;Chang Aying;Yang Zhengchun;Liu Liru(Clinical College,Dali University,Dali,Yunnan 671000,China;The First Affiliated Hospital of Dali University,Dali,Yunnan 671000,China)

机构地区：[1]大理大学临床医学院,云南大理671000 [2]大理大学第一附属医院,云南大理671000

出　　处：《大理大学学报》2023年第4期54-59,共6页Journal of Dali University

基　　金：云南省教育厅科学研究基金项目(2021J0389)。

摘　　要：目的:分析低钙与标准钙透析液分段枸橼酸抗凝血液透析治疗高危出血风险尿毒症患者的使用效果。方法:以2021年1月至2022年1月在大理大学第一附属医院接受血液透析治疗的高危出血风险患者为研究对象,分别使用低钙透析液(对照组)与标准钙透析液(观察组)行分段枸橼酸抗凝。比较2组患者治疗前一般资料、治疗后0.5、2.0、3.0 h动脉端和静脉端游离钙离子浓度、动脉端及静脉壶枸橼酸输注量、透析器及管路凝血情况和不良事件发生率。结果:观察组在相同时间段内动脉端和静脉端游离钙离子浓度均显著高于对照组,动脉端及静脉壶枸橼酸输注速度快,透析持续时间短,差异均有统计学意义(P<0.05);观察组在透析管路(尤其静脉壶处)的总凝血率高于对照组,但不良事件的发生率显著低于对照组,差异有统计学意义(P<0.05)。结论:采用标准钙透析液透析安全性高,不良事件发生情况少,静脉壶是主要凝血部位,可在综合评估患者情况下增加枸橼酸输注量、频繁多次监测滤后钙水平可保证透析顺利完成。Objective:To analyze the effect of low calcium and standard calcium dialysate segmented citrate anticoagulant hemodialysis in the treatment of uremia patients with high risk of bleeding.Methods:High-risk bleeding patients undergoing hemodialysis at the First Affiliated Hospital of Dali University from January 2021 to January 2022 were enrolled in the study.Low calcium dialysate(control group)and standard calcium dialysate(observation group)were used for segmented citrate anticoagulation.The general data before treatment,the concentration of free calcium ions at the arterial and venous ends at 0.5,2.0,and 3.0 hours after treatment,the amount of citrate infused at the arterial and venous pot,the coagulation status of the dialyzer and pipeline,and the incidence of adverse events were compared between the two groups.Results:The concentration of free calcium ions in the arterial end and venous end of the observation group was significantly higher than that of the control group at the same time period.The infusion speed of citrate in the arterial end and venous pot was faster,and the duration of dialysis was shorter.The differences had statistical significance(P<0.05).The total coagulation rate of the dialysis pipeline(especially the venous pot)in the observation group was higher than that in the control group,but the incidence of adverse events was significantly lower in the observation group than in the control group,with statistical significance(P<0.05).Conclusion:The use of standard calcium dialysate with segmented citrate anticoagulation is safe and associated with fewer adverse events.The venous pot is the main coagulation site,and increasing the amount of citrate infusion and monitoring the calcium level after filtration frequently can ensure smooth completion of hemodialysis in patients with high-risk bleeding.

关 键 词：低钙透析液 标准钙透析液 分段枸橼酸抗凝 血液透析 高危出血 

分 类 号：R459.5[医药卫生—治疗学]