枸橼酸钠局部抗凝在重症医学科血液净化中的临床应用  

Clinical application of regional sodium citrate anticoagulation in blood purification in critical care medicine

作　　者：马腾飞 刘春峰[1] 姚炳荣[1] 施红伟[1] 陈瑢 MA Teng-fei;LIU Chun-feng;YAO Bing-rong(Department of Critical Care Medicine,Rudong County People's Hospital,Nantong 226400,China)

机构地区：[1]如东县人民医院重症医学科,226400

出　　处：《中国实用医药》2023年第19期107-109,共3页China Practical Medicine

摘　　要：目的针对重症医学科血液净化患者实施枸橼酸钠局部抗凝治疗,进一步分析其应用成果和治疗安全性。方法108例重症医学科血液净化患者,采用随机数字表法分为对照组与观察组,每组54例。对照组患者采用常规低分子肝素抗凝措施,观察组患者采用枸橼酸钠局部抗凝治疗。比较两组患者治疗前后血液生化指标[pH、离子钙(iCa^(2+))、钠离子(Na^(+))、碳酸氢根(HCO_(3)^(-))、肌酐(Scr)]、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)及不良事件发生情况。结果治疗后,对照组患者APTT、PT、TT均长于本组治疗前,差异具有统计学意义(P<0.05);治疗后,观察组患者APTT、PT、TT分别为(26.1±3.2)、(12.1±3.7)、(19.8±4.1)s,短于对照组的(49.1±2.6)、(18.3±3.4)、(24.5±4.5)s,差异具有统计学意义(P<0.05)。治疗后,观察组血液pH、iCa^(2+)以及Na^(+)水平分别为(7.5±0.6)、(1.4±0.4)、(143.5±9.6)mmol/L,与对照组的(7.4±0.7)、(1.3±0.4)、(144.1±9.9)mmol/L比较,差异无统计学意义(P>0.05);观察组HCO_(3)^(-)(18.8±3.5)mmol/L、Scr(402.5±48.1)μmol/L低于对照组的(22.6±5.1)mmol/L、(488.4±90.6)μmol/L,差异具有统计学意义(P<0.05)。观察组患者不良事件发生率为5.6%(3/54),低于对照组的20.4%(11/54),差异具有统计学意义(P<0.05)。结论枸橼酸钠局部抗凝治疗重症医学科血液净化患者效果较好,能够稳定血液生化指标,且凝血功能不会发生大的波动,治疗安全性高,故而可推广应用。Objective To further analyze the effect and therapeutic safety of regional sodium citrate anticoagulation in blood purification in critical care medicine.Methods A total of 108 patients with blood purification in critical care medicine were divided into control group and observation group according to the random numerical table,with 54 cases in each group.The control group was treated with conventional low molecular weight heparin anticoagulation,and the observation group was treated with regional sodium citrate anticoagulation.Both groups were compared in terms of blood biochemical indexes[pH,ionic calcium(iCa^(2+)),sodium(Na^(+)),bicarbonate(HCO_(3)^(-)),serum creatinine(Scr)],activated partial prothrombin time(APTT),prothrombin time(PT),thrombin time(TT)before and after treatment,and the occurrence of adverse events.Results After treatment,APTT,PT and TT in the control group were all longer than those before treatment in this group,and the difference was statistically significant(P<0.05).After treatment,APTT,PT and TT of the observation group were(26.1±3.2),(12.1±3.7)and(19.8±4.1)s,which were shorter than those of(49.1±2.6),(18.3±3.4)and(24.5±4.5)s of the control group,and the differences were statistically significant(P<0.05).After treatment,the blood pH,iCa^(2+)and Na^(+)levels in the observation group were(7.5±0.6),(1.4±0.4)and(143.5±9.6)mmol/L,which were statistically significant when compared with those of(7.4±0.7),(1.3±0.4)and(144.1±9.9)mmol/L in the control group(P>0.05).HCO_(3)^(-)of(18.8±3.5)mmol/L and Scr of(402.5±48.1)μmol/L in the observation group were lower than those of(22.6±5.1)mmol/L and(488.4±90.6)μmol/L in the control group,and the differences were statistically significant(P<0.05).The incidence of adverse events in the observation group was 5.6%(3/54),which was lower than that of 20.4%(11/54)in the control group,and the difference was statistically significant(P<0.05).Conclusion Regional sodium citrate anticoagulant has good effect for blood purification patients in critic

关 键 词：枸橼酸钠 局部抗凝 重症医学科 血液净化治疗 临床应用 

分 类 号：R459.5[医药卫生—治疗学]