两种抗凝方法在重症高危出血倾向患者持续静脉-静脉血液滤过治疗中的效果探讨  

Exploration of the effects of two anticoagulation methods in the treatment of continuous veno-venous hemofiltration in critically ill patients at high-risk of bleeding tendency

作　　者：张金英 ZHANG Jin-ying(Ningjin County People's Hospital,Dezhou 253400,China)

机构地区：[1]宁津县人民医院,253400

出　　处：《中国实用医药》2025年第1期106-109,共4页China Practical Medicine

摘　　要：目的讨论两种抗凝方法在重症高危出血倾向患者持续静脉-静脉血液滤过治疗中的价值。方法74例行持续静脉-静脉血液滤过治疗的重症高危出血倾向患者为研究对象,应用随机数字表法分为参照组和试验组,每组37例。参照组应用全身低分子肝素抗凝方案,试验组采取局部枸橼酸抗凝方案。对比两组患者的凝血指标、滤器使用情况、内环境、肝功能、出血情况。结果试验组滤器使用时间(52.68±4.21)h、滤器后凝血时间(25.81±2.42)s、体内凝血时间(15.84±2.49)s均比参照组的(25.70±3.36)h、(11.10±2.49)s、(9.79±2.52)s更长,组间差异明显(P<0.05)。试验组pH值(7.43±0.02)、总钙(tCa)(2.33±0.01)mmol/L、血清离子钙(iCa)(1.24±0.05)mmol/L、丙氨酸氨基转移酶(30.77±0.16)U/L、总胆红素(15.79±2.08)μmol/L、直接胆红素(4.59±0.21)μmol/L均比参照组的(7.23±0.04)、(2.26±0.03)mmol/L、(1.10±0.04)mmol/L、(28.75±0.23)U/L、(12.03±1.14)μmol/L、(3.39±0.19)μmol/L高,血清钠离子(Na+)(138.12±1.45)mmol/L及出血发生率13.51%均比参照组的(140.90±1.35)mmol/L、35.14%低,组间差异明显(P<0.05)。干预前,两组活化部分凝血活酶时间、凝血酶原时间、凝血酶时间、国际标准化比值(INR)均无统计学价值(P>0.05);干预后,两组凝血酶原时间、凝血酶时间、INR均无统计学价值(P>0.05);试验组干预后活化部分凝血活酶时间(36.20±4.09)s短于参照组的(39.95±3.07)s,组间差异明显(P<0.05)。结论两种抗凝方法应用于重症高危出血倾向患者持续静脉-静脉血液滤过治疗中均有良好的抗凝效果,其中局部枸橼酸抗凝的效果更为显著,不会对内环境的稳定造成影响,其有助于延长滤器使用时间。Objective To explore the value of two anticoagulation methods in the treatment of continuous veno-venous hemofiltration in critically ill patients at high-risk of bleeding tendency.Methods 74 cases of critically ill patients at high-risk of bleeding tendency who underwent continuous veno-venous hemofiltration were selected as study subjects,and were divided into the reference group and the experimental group by random number table method,with 37 cases in each group.The reference group was treated with systemic low molecular weight heparin anticoagulant regimen,and the experimental group was treated with local citric acid anticoagulant regimen.The blood coagulation index,filter use,internal environment,liver function and bleeding were compared between the two groups.Results In the experimental group,the filter use time was(52.68±4.21)h,the post-filter clotting time was(25.81±2.42)s,and the in vivo clotting time was(15.84±2.49)s,which were longer than(25.70±3.36)h,(11.10±2.49)s,and(9.79±2.52)s in the reference group,and the differences between the two groups were significant(P<0.05).In the experimental group,pH value was(7.43±0.02),the total calcium(tCa)was(2.33±0.01)mmol/L,the serum ionized calcium(iCa)was(1.24±0.05)mmol/L,the alanine aminotransferase was(30.77±0.16)U/L,the total bilirubin was(15.79±2.08)μmol/L,and the direct bilirubin was(4.59±0.21)μmol/L,which were higher than(7.23±0.04),(2.26±0.03)mmol/L,(1.10±0.04)mmol/L,(28.75±0.23)U/L,(12.03±1.14)μmol/L,and(3.39±0.19)μmol/L in the reference group;the serum sodium ion(Na+)and incidence of bleeding were(138.12±1.45)mmol/L and 13.51%in the experimental group,which were lower than(140.90±1.35)mmol/L and 35.14%in the reference group;the difference between the two groups was significant(P<0.05).Before intervention,there was no statistical value in activated partial thromboplastin time,prothrombin time,thrombin time and international normalized ratio(INR)between the two groups(P>0.05).After intervention,there was no statistical value in prot

关 键 词：出血倾向患者 持续静脉-静脉血液滤过 低分子肝素 抗凝方案 

分 类 号：R47[医药卫生—护理学]