局部枸橼酸钠抗凝在重症急性肾损伤患者连续性肾脏替代疗法中的应用效果及对炎症的影响  

Effect of Local Sodium Citrate Anticoagulation and Its Effect on Inflammation in Patients with Severe Acute Kidney Injury During Continuous Renal Replacement Therapy

作　　者：汪易岚 曹岚 张茜 叶宏伟 WANG Yian;CAO Lan;ZHANG Qian;YE Hongwei(Department of Critical Care Medicine,Changshu Hospital Affiliated to Soochow University(Changshu First People's Hospital),Changshu,Jiangsu Province,215500 China)

机构地区：[1]苏州大学附属常熟医院(常熟市第一人民医院)重症医学科,江苏常熟215500

出　　处：《中外医疗》2023年第21期14-17,共4页China & Foreign Medical Treatment

基　　金：2019年苏州市卫生计生委科技项目(LCZX201922)。

摘　　要：目的 探讨对重症急性肾损伤患者在连续肾脏替代疗法中予局部枸橼酸钠抗凝的效果及对炎症的影响。方法 方便选择2020年1月—2022年12月常熟市第一人民医院收治的重症急性肾损伤患者112例为研究对象,均予连续性肾脏替代疗法治疗,随机分为普通肝素抗凝的对照组(n=56)与局部枸橼酸钠抗凝的观察组(n=56),比较两组凝血功能、肾功能以及炎症反应指标。结果 治疗后观察组凝血活酶时间(34.58±3.11)s、凝血酶原时间(13.73±2.07)s、凝血酶时间(15.73±2.15)s低于对照组,差异有统计学意义(t=8.046、9.727、6.845,P<0.05)。治疗后观察组尿素氮(6.64±1.85)mmol/L、血清肌酐(105.37±10.47)mmol/L、β2微球蛋白(2.85±0.75)mg/L均低于对照组,差异有统计学意义(t=7.208、3.056、3.973,P<0.05)。治疗后观察组超敏C反应蛋白、白介素-4、白介素-6水平均低于对照组,差异有统计学意义(P<0.05)。结论 对重症急性肾损伤患者采用连续性肾脏替代疗法治疗期间予局部枸橼酸钠抗凝能减少对全身凝血功能的影响,还可改善患者肾功能,减轻炎症反应。Objective To explore the effect of local sodium citrate anticoagulation and its influence on inflammation in patients with severe acute kidney injury during continuous renal replacement therapy.Methods 112 patients with severe acute kidney injury admitted to Changshu First People's Hospital from January 2020 to December 2022 were conveniently selected as the study subjects,all received continuous renal replacement therapy.They were randomly divided into a control group (n=56) treated with ordinary heparin anticoagulation and an observation group (n=56)treated with local sodium citrate anticoagulation.The coagulation function,renal function,and inflammatory response indicators of the two groups were compared.Results After treatment,the APTT (34.58±3.11) s,PT (13.73±2.07) s,and TT (15.73±2.15) s in the observation group were lower than those in the control group,the difference was statistically significant (t=8.046,9.727,6.845,P<0.05).After treatment,BUN (6.64±1.85) mmol/L,SCr (105.37±10.47) mmol/L β2-MG (2.85±0.75) mg/L,were lower than those in the control group,the difference was statistically significant (t=7.208,3.056,3.973,P<0.05).After treatment,the levels of hs-CRP,IL-4,and IL-6 in the observation group were significantly lower than those in the control group,the difference was statistically significant (P<0.05).Conclusion Local sodium citrate anticoagulant during continuous renal replacement therapy in patients with severe acute kidney injury can reduce the impact on systemic coagulation function,improve renal function,and reduce inflammatory response.

关 键 词：枸橼酸钠抗凝 重症急性肾损伤 连续肾脏替代疗法 凝血功能 肾功能 炎症反应 

分 类 号：R4[医药卫生—临床医学]