两段式4%枸橼酸钠抗凝在有高危出血倾向血液透析患者的应用  

Application of two-stage 4%sodium citrate anticoagulation in hemodialysis patients with high-risk bleeding tendency

作　　者：王玉英 夏日东 刘小勇 高新英 WANG Yuying;XIA Ridong;LIU Xiaoyong;GAO Xinying(Department of Nephrology,Xining First People's Hospital,Xining 810000,CHINA)

机构地区：[1]西宁市第一人民医院肾内科,青海810000

出　　处：《江苏医药》2024年第10期1012-1015,1019,共5页Jiangsu Medical Journal

基　　金：西宁市科技计划项目(2022-M-13)。

摘　　要：目的观察两段式4%枸橼酸钠抗凝在有高危出血倾向血液透析患者的应用效果。方法100例行血液透析治疗且有高危出血倾向的患者随机均分为两组,每组50例。血液透析治疗时,A组采用两段式4%枸橼酸钠抗凝,B组采用低分子肝素抗凝。观察两组透析器及血管路的静脉壶凝血情况。比较两组血液透析前后凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(Fib)、Ca^(2+)、Na^(+)、K^(+)、P^(3+)、二氧化碳结合力(CO_(2)CP)、单室尿素清除指数(spKt/V)、尿素下降率(URR)和完成治疗时间。记录两组血液透析治疗期间的不良反应。结果A组患者血液透析前后TT、APTT、PT、Fib比较差异无统计学意义(P>0.05),而B组血液透析后TT、APTT、PT较血液透析前延长(P<0.05)。两组透析器和静脉壶有凝血患者的比例相仿(P>0.05)。两组血液透析后Ca^(2+)、Na^(+)、K^(+)、P^(3+)、CO_(2)CP、spKt/V、URR及完成治疗时间比较均无统计学差异(P>0.05)。两组血液透析治疗期间不良反应发生率比较无统计学差异(P>0.05)。结论两段式4%枸橼酸钠抗凝用于有高危出血倾向的血液透析患者安全、有效。Objective To observe the effect of two-stage 4%sodium citrate anticoagulation in hemodialysis patients with high-risk bleeding tendency.Methods A total of 100 hemodialysis patients with high-risk bleeding tendency were randomly divided into two groups with 50 cases each.During hemodialysis treatment,group A was treated with two-stage 4%sodium citrate anticoagulation and group B was treated with low molecular weight heparin anticoagulation.The blood coagulation of dialyzer and venous pot was observed.The thrombin time(TT),activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen(Fib),Ca^(2+),Na^(+),K^(+),P^(3+),carbon dioxide combining power(CO_(2)CP),single ventricular urea clearance index(spKt/V)and urea decline rate(URR)before and after hemodialysis and treatment completion time were compared between the two groups.The adverse responses were recorded during treatment.Results There were no significant differences in TT,APTT,PT and Fib before and after hemodialysis in group A(P>0.05),while TT,APTT and PT after hemodialysis in group B were longer than those before hemodialysis(P<0.05).There was no significant difference in the proportion of blood clotting of dialyzer and venous pot between the two groups(P>0.05).There were no significant differences in Ca^(2+),Na^(+),K^(+),P^(3+),CO_(2)CP,spKt/V,URR after hemodialysis,and treatment completion time between the two groups(P>0.05).The incidence of adverse responses was similar between the two groups(P>0.05).Conclusion In hemodialysis patients with high-risk bleeding tendency,two-stage 4%sodium citrate anticoagulation is safe and effective.

关 键 词：枸橼酸钠 抗凝剂 血液透析 出血倾向 

分 类 号：R692[医药卫生—泌尿科学]