局部枸橼酸钠抗凝在单重血浆置换中的应用及安全性分析  

作　　者：高良云 朱星瑜[1] 王悦琳[1] 金飞英 胡日红[1] 姚国明[1] 

机构地区：[1]浙江中医药大学附属杭州市中医院,310007

出　　处：《浙江临床医学》2024年第4期544-546,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省基础公益研究计划(LGF21H050002);杭州市医学重点学科建设项目(杭卫发[2021]21号)。

摘　　要：目的探讨局部4%枸橼酸钠注射液在单重血浆置换抗凝中的应用,并评估该方法的安全性。方法回顾性分析2015年1月至2022年6月单重血浆置换的患者52例,根据抗凝方式分为枸橼酸组和低分子肝素组,共进行血浆置换144次。枸橼酸组抗凝方案:4%枸橼酸从膜型血浆分离器前输注,根据置换液成分进行调整,置换血浆时,枸橼酸钠流量为120 mL/h;置换白蛋白稀释液、林格注射液时,枸橼酸流量调整为140 mL/h。5%葡萄糖酸钙采用微泵外周静脉输注,根据输注总量和血浆置换时间全程匀速输注。低分子肝素组抗凝方案:根据患者体质量,在治疗前20~30 min一次性静脉注射60~80 IU/kg,治疗期间不另追加。观察两组患者行血浆置换治疗时抗凝效果及不良反应发生情况。结果枸橼酸组共进行血浆置换44次,未发生抗凝失败;低分子肝素组共进行血浆置换100次,发生5次抗凝失败,两组患者未发生明显出血、低钙血症、肌肉痉挛等并发症。枸橼酸组发生滤器血凝级别2~3级、动脉壶血凝块、静脉壶血凝块比例低于低分子肝素组(P<0.05)。枸橼酸抗凝前后比较,离子钙变化差异有统计学意义(P=0.002)。结论局部枸橼酸钠抗凝方案在血浆置换治疗中简单易行,相对传统低分子肝素,其抗凝效果更加理想、应用范围更广,且安全有效。Objective To investigate the clinical application of sodium citrate anticoagulant regimen in single plasma exchange therapy,and to evaluate the safety of this regimen.Methods A retrospective study was conducted on 52 patients admitted to the Renal Department of Hangzhou Hospital of Traditional Chinese Medicine from January 2015 to June 2022 who received single double plasma exchange.The patients were divided into the citric acid group and the low molecular weight heparin group according to the anticoagulation method.A total of 144 times of plasma exchange were performed.Anticoagulant regimen of citric acid group:4%citric acid was transfused before membrane plasma separator,adjusted according to the composition of the replacement liquid,and the flow rate of sodium citrate during plasma replacement was 120 mL/h.The flow rate of citric acid was adjusted to 140 mL/h when the albumin diluent and Ringer injection were replaced.The peripheral intravenous infusion of 5%calcium gluconate was performed with a micro-pump at a constant rate throughout the whole process according to the total amount of infusion and plasma exchange time.Anticoagulation regimen of LMWH group:according to the patient's body weight,a one-time intravenous injection of 60 to 80IU/kg was given 20 to 30 minutes before the treatment,and no additional injection was made during the treatment.The anticoagulation effect and the occurrence of adverse reactions were observed in the two groups.Results The citric acid group underwent plasma exchange 44 times without anticoagulation failure.In the low molecular weight heparin group,a total of 100 times of plasma exchange occurred,5 times of anticoagulation failure occurred,and no significant bleeding,hypocalcemia,muscle spasm and other complications occurred in the two groups.The proportion of filter grade 2 to 3,arterial and venous kettle clots in citric acid group were lower than those in low molecular weight heparin group(P<0.05).The changes of ionic calcium before and after citric acid anticoagulation were

关 键 词：血浆置换 枸橼酸钠 低钙血症 

分 类 号：R457.14[医药卫生—治疗学]