枸橼酸钠抗凝在老年日间连续性静脉-静脉血液透析中的效果观察  

Efficacy and safety of regional citrate anticoagulation during daily continuous venovenous hemodialysis in elderly patients

作　　者：刘子云 李凝旭[1] LIU Ziyun;LI Ningxu(Department of Nephrology,Liyuan Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430074,China)

机构地区：[1]华中科技大学同济医学院附属梨园医院肾内科,湖北省武汉市430074

出　　处：《实用老年医学》2024年第6期564-567,共4页Practical Geriatrics

摘　　要：目的探讨枸橼酸钠抗凝(regional citrate anticoagulation,RCA)在老年病人日间连续性静脉-静脉血液透析(continuous venovenous hemodialysis,CVVHD)中的有效性和安全性。方法选择华中科技大学同济医学院附属梨园医院肾内科血液净化中心2022年3月至2023年2月行日间RCA-CVVHD治疗的50例老年病人作为研究对象,检测治疗前后肾功能和电解质,治疗过程中监测滤器前和滤器后血气分析指标,治疗结束后记录滤器及体外循环管路凝血分级情况。结果(1)50例病人50次CVVHD治疗均顺利完成,滤器及静脉壶凝血程度分级均为0级。(2)治疗1 h滤器后游离钙(iCa^(2+))水平为(0.36±0.05)mmol/L。(3)治疗2、5 h滤器前血气分析结果显示,体内iCa^(2+)水平较治疗前下降(P<0.05),pH值、碳酸氢根离子(HCO_(3)^(-))、碱剩余(BE)水平较治疗前上升(P<0.05),钠离子(Na^(+))水平较治疗前无明显变化(P>0.05)。(4)治疗后BUN、血肌酐(Cr)、钾离子(K+)、氯离子(Cl^(-))、血磷(P)、血钙(Ca^(2+))水平均较治疗前下降(P<0.05),HCO_(3)^(-)水平较治疗前上升(P<0.05);治疗前后Na+水平无明显变化(P>0.05)。(5)治疗过程中发生1例枸橼酸钠蓄积。结论老年病人使用RCA行日间CVVHD治疗是安全和有效的;治疗时为避免枸橼酸钠蓄积或者枸橼酸钠过量,需要动态监测体内静脉血气分析指标。Objective To investigate and evaluate the efficacy and safety of regional citrate anticoagulation(RCA)in elderly patients undergoing daytime continuous venovenous hemodialysis(CVVHD).Methods A total of fifty elderly patients who received daytime RCA-CVVHD treatment from March 2022 to February 2023 in Blood Purification Center,Liyuan Hospital,Tongji Medical College,Huazhong University of Science and Technology were studied retrospectively.Renal function and electrolytes were detected before and after the treatment,and the venous blood gas indicators of the extracorporeal circulation were monitored during the treatment process.The clotting grade of the filter and extracorporeal circulation pipeline was recorded after the treatment.Results(1)All CVVHD in the 50 patients were successfully completed,with no coagulation occurring in the filters and venous pots.(2)The level of ionized calcium(iCa^(2+))after the filter one hour after the treatment was(0.36±0.05)mmol/L.(3)The blood iCa^(2+)level was decreased(P<0.05),while the levels of pH,bicarbonate ion(HCO_(3)^(-)),base excess(BE)were increased 2 and 5 h after treatment compared to pre-treatment levels(P<0.05).Sodium ion(Na+)level showed no significant change(P>0.05).(4)The levels of blood urea nitrogen(BUN),serum creatinine(Cr),potassium ion(K+),chloride ion(Cl^(-)),blood phosphate(P)and calcium(Ca^(2+))were decreased,while the level of HCO_(3)^(-)was increased after treatment(P<0.05).There was no significant change in Na+level after treatment(P>0.05).(5)There was one case of sodium citrate accumulation during the treatment process.Conclusions The application of daytime RCA-CVVHD in elderly patients is safe and effective.To avoid sodium citrate accumulation or overdose,dynamic monitoring of venous blood gas indicator is necessary during treatment.

关 键 词：连续性血液净化 老年人 枸橼酸钠抗凝 

分 类 号：R495.5[医药卫生—康复医学]