危重烧伤脓毒症患者连续性血液净化过程中应用枸橼酸钠抗凝的效果分析  

Application Effect Analysis of Sodium Citrate Anticoagulation during the Continuous Blood Purification in Patients with Critically Severe Burn Sepsis

作　　者：徐苗 钟洪涛 贺宇 XU Miao;ZHONG Hongtao;HE Yu(Department of Emergency,The First Affiliated Hospital of Nanyang Medical College,Nanyang,Henan 473000,China;Department of General Surgery,The Second Affiliated Hospital of Nanyang Medical College,Nanyang,Henan 473004,China)

机构地区：[1]南阳医学高等专科学校第一附属医院急诊科,河南南阳473000 [2]南阳医学高等专科学校第二附属医院普外科,河南南阳473004

出　　处：《中国烧伤创疡杂志》2024年第6期447-450,共4页The Chinese Journal of Burns Wounds & Surface Ulcers

摘　　要：目的分析危重烧伤脓毒症患者连续性血液净化过程中应用枸橼酸钠抗凝的临床疗效。方法选取2019年1月至2023年4月南阳医学高等专科学校第一附属医院收治的82例危重烧伤脓毒症患者作为研究对象,按照不同抗凝方法将其分为研究组(41例)和对照组(41例),研究组患者进行连续性血液净化时采用枸橼酸钠抗凝,对照组患者进行连续性血液净化时采用肝素抗凝,对比观察两组患者炎症指标水平、氧合指数、乳酸水平以及凝血功能。结果血液净化后,研究组患者中性粒细胞计数(NEUT)、白细胞计数(WBC)以及白细胞介素(IL)-6、IL-8、肿瘤坏死因子-α(TNF-α)、乳酸水平均明显低于对照组(t=13.365、5.723、4.919、5.049、8.526、9.911,P均<0.001),氧合指数明显高于对照组(t=5.177,P<0.001),凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)均明显短于对照组(t=7.454、6.578,P均<0.001)。结论与应用肝素抗凝相比,连续性血液净化时采用枸橼酸钠抗凝更能有效减轻危重烧伤脓毒症患者的炎症反应,增加氧气供应,减少乳酸堆积,且对患者凝血功能影响更小。Objective To analyze the application effect of sodium citrate anticoagulation during the continuous blood purification in patients with critically severe burn sepsis.Methods 82 patients with critically severe burn sepsis admitted to The First Affiliated Hospital of Nanyang Medical College from January 2019 to April 2023 were enrolled as research subjects,and divided into the study group(n=41)receiving sodium citrate anticoagulation during the continuous blood purification,and the control group(n=41)receiving heparin anticoagulation during the continuous blood purification.The inflammatory factor level,oxygenation index,lactic acid level and coagulation function were compared between the two groups.Results After blood purification,neutrophil count(NEUT),white blood cell count(WBC),and the levels of interleukin(IL)⁃6,IL⁃8,tumor necrosis factor⁃α(TNF⁃α)and lactic acid of patients were all significantly lower in the study group compared with the control group(t=13.365,5.723,4.919,5.049,8.526 and 9.911,all P<0.001),oxygenation index was significantly higher in the study group(t=5.177,P<0.001),and prothrombin time(PT)and activated partial thromboplastin time(APTT)were significantly shorter in the study group(t=7.454 and 6.578,both P<0.001).Conclusion Compared with the application of heparin anticoagulation in patients with critically severe burn sepsis,the application of sodium citrate anticoagulation during the continuous blood purification is more effective in reducing the inflammatory response of patients,increasing their supply of oxygen,decreasing the accumulation of lactic acid,and exerting less influence on their coagulation function.

关 键 词：枸橼酸钠 危重烧伤脓毒症 连续性血液净化 抗凝 凝血功能 炎症 

分 类 号：R644[医药卫生—外科学] R459.7[医药卫生—临床医学]