优化枸橼酸钠剂量在高危出血风险血液透析患者中应用的研究  

Study on Optimal Dosage of Sodium Citrate in Hemodialysis Patients at High Risk of Bleeding

作　　者：吴丽华[1] 王吉萍[1] 陈海金[1] 朱俊雅 Wu Lihua(Guangdong Agricultural Reclamation Central Hospital,Zhanjiang 524002)

机构地区：[1]广东省农垦中心医院,广东湛江524002

出　　处：《黑龙江医药》2023年第3期517-520,共4页Heilongjiang Medicine journal

基　　金：湛江市非资助科技攻关专题(项目编号:2021B01049)。

摘　　要：目的:分析优化枸橼酸钠剂量在高危出血风险血液透析患者中的临床治疗效果。方法:将我院2021年5月—2022年12月80例次高危出血风险血液透析患者(采用随机数字表法把相同血液循环通路类型的患者)分为4组:A、B、C、D,每组20例次,四组单位时间内血流量(mL/min)与4%枸橼酸钠抗凝剂总量(mL/h)比例分别为1.0∶0.8、1.0∶1.0、1.0∶1.2及1.0∶1.5。统计4组患者的滤器使用时间、穿刺点压迫时间、部分凝血活酶时间、血钙、血钠、超滤量、尿素氮下降率;比较4组患者的体外循环凝血分级。结果:A组患者的滤器使用时间明显短于B组、B组短于C组、C组短于D组,差异具有统计学意义(P<0.05)。4组患者的穿刺点压迫时间和部分凝血活酶时间对比,差异不具有统计学意义(P>0.05)。4组患者的血钙、血钠指标对比,差异不具有统计学意义(P>0.05)。4组患者的超滤量、尿素清除指数、尿素氮下降率比较,差异不具有统计学意义(P>0.05)。相比于A、B、C组,D组的0级率更高,差异具有统计学意义(P<0.05)。结论:相比于常规剂量,优化后的枸橼酸钠低剂量在高危出血风险血液透析患者中的临床治疗效果更佳,能在稳定患者各项基本指标的基础上,减少出血事件的发生,确保治疗的安全性,减轻患者经济负担。Objective:To analyze the therapeutic effect of sodium citrate dose optimization in hemodialysis patients at high risk of bleeding.Methods:A total of 80 hemodialysis patients with high-risk bleeding risk in our hospital from May 2021 to December 2022(patients with the same blood circulation access type were randomly numbered table method)were divided into 4 groups:A,B,C,D,20 cases in each group,the proportion of blood flow per unit time(mL/min)to total amount of 4%sodium citrate anticoagulant(mL/h)in the four groups was 1.0∶0.8,1.0∶1.0,1.0∶1.2 and 1.0∶1.5,respectively.Filter use time,puncture point compression time,partial thromboplastin time,blood calcium,blood sodium,ultrafiltration volume,urea nitrogen reduction rate of the 4 groups were analyzed.The blood coagulation grading of extracorporeal circulation in 4 groups was compared.Results:The filter use time of group A was significantly shorter than that of group B,B was shorter than that of group C,and C was shorter than that of group D,and the difference was statistically significant(P<0.05).There was no significant difference in puncture point compression time and partial thrombin time between the 4 groups(P>0.05).There was no statistical significance in serum calcium and sodium indexes of 4 groups(P>0.05).There was no statistical significance in ultrafiltration volume,urea clearance index and urea nitrogen reduction rate among 4 groups(P>0.05).Compared with groups A,B and C,the rate of grade 0 in group D was higher,and the difference was statistically significant(P<0.05).Conclusions:Compared with the conventional dose,the optimized low dose of sodium citrate has better clinical therapeutic effect in high-risk bleeding risk hemodialysis patients,which can reduce the occurrence of bleeding events,ensure the safety of treatment and reduce the economic burden of patients on the basis of stabilizing the basic indicators of patients.

关 键 词：枸橼酸钠 剂量 高危出血风险 血液透析 

分 类 号：R692.5[医药卫生—泌尿科学]