不同缓冲剂碳酸氢盐透析液在无肝素血液透析患者中的应用研究  

Application of different buffer bicarbonate dialysates in hemodialysis patients without anticoagulant heparin

作　　者：王越[1] 李梦婷[1] 谢庆磊 张留平[1] 汤日宁[1] Wang Yue;Li Meng-ting;Xie Qing-lei;Zhang Liu-ping;Tang Ri-ning(Department of Nephrology,ZhongDa Hospital Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院肾内科,南京210009

出　　处：《临床肾脏病杂志》2023年第7期536-540,共5页Journal Of Clinical Nephrology

摘　　要：目的比较枸橼酸碳酸氢盐透析液与醋酸碳酸氢盐透析液应用于无肝素血液透析的效果,为临床选用合适的透析液提供依据。方法采用自身对照设计,纳入2021年1月至8月在东南大学附属中大医院血液净化中心的维持性血液透析患者42例,每例患者连续进行2次无肝素血液透析,分别使用枸橼酸盐透析液和醋酸盐透析液各1次。比较患者分别使用两种透析液治疗前后血小板、pH、碳酸氢根离子(HCO_(3)^(−))、钙离子(Ca^(2+))、凝血指标、体外循环管路及滤器的凝血情况、透析治疗完成情况、不良反应等。结果使用枸橼酸盐和醋酸盐透析液时患者均能较好的耐受治疗,未出现恶心呕吐、低血压、肌肉痉挛、低血钙、出血等不良反应和并发症。患者在两种透析液治疗前血小板、pH、HCO_(3)^(−)、Ca^(2+)、凝血酶原时间(prothrombin time,PT)、国际标准化比值(international normalized ratio,INR)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)、纤维蛋白原(fibrinogen,FIB-C)差异无统计学意义(P>0.05),治疗后的血小板、pH、APTT差异无统计学意义(P>0.05),HCO_(3)^(−)、Ca^(2+)、PT、INR、TT、FIB-C差异有统计学意义(P<0.05)。枸橼酸盐组体外循环管路及滤器凝血分级程度较醋酸盐组轻,治疗完成率高(85.7%比64.3%,P<0.05)。结论枸橼酸盐透析液在无肝素血液透析临床应用中的安全性与醋酸盐透析液相当,体外循环管路及滤器的凝血情况、透析治疗完成情况均优于醋酸盐透析液。Objective To compare the efficacies of citrate bicarbonate dialysate versus acetate bicarbonate dialysate for hemodialysis without anticoagulant to provide rationales for selecting an optimal dialysate.Methods For this self-control study,42 maintenance hemodialysis patients were recruited.Each subject underwent hemodialysis twice without anticoagulant.Citrate bicarbonate dialysate and acetate bicarbonate dialysate were used once each.Two groups were compared with regards to platelet,pH,HCO_(3)^(−),Ca^(2+),coagulation index,coagulation of cardiopulmonary bypass(CPB)pipeline/filter,treatment completion rate and adverse reactions before and after each dialysis.Result Both groups could well-tolerate the treatment and there were no adverse reactions of nausea,vomiting,hypotension,muscle spasm,hypocalcemia or hemorrhage.No significant inter-group differences existed in platelet,pH,HCO_(3)^(−),Ca^(2+),prothrombin time(PT),international normalized ratio(INR),activated partial thromboplastin time(APTT),thrombin time(TT)or fibrinogen(FIB-C)pre-treatment(P>0.05).No significant differences existed in platelet,PH or APTT post-treatment(P>0.05).However,significant differences existed in HCO_(3)^(−),Ca^(2+),PT,INR,TT and FIB-C(P<0.05).The degree of coagulation grading of CPB pipeline/filter was lighter in citric acid group than that in acetic acid group.And completion rate of treatment was higher(85.7%vs 64.3%,P<0.05).Conclusion In clinical application of hemodialysis without anticoagulant,the safety of citrate bicarbonate dialysate is equivalent to that of acetate bicarbonate dialysate.Coagulation condition of CPB pipeline/filter and completion of dialysis treatment are better than those of acetate bicarbonate dialysate.

关 键 词：缓冲剂 透析液 血液透析 

分 类 号：R692.5[医药卫生—泌尿科学]