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目的回顾性分析低分子量肝素抗凝在连续性肾脏替代治疗中致腰大肌血肿一例的诊治过程,为临床疾病治疗提供依据。方法 2015年12月于南通大学附属南京江北人民医院重症医学科收治一例因慢性肾功能不全行连续性肾脏替代疗法(CRRT)治疗的使用低分子量肝素抗凝导致腰大肌出血患者,对其临床基本资料进行回顾性分析,总结其诊治经验。结果患者入院后予以舒普深抗感染、化痰、腹膜透析等治疗,症状未改善。行胸腹部CT检查提示:肝脓肿,予泰能联合莫西沙星抗感染,同时请介入科在B超定位下行经皮肝脓肿穿刺引流术,见黄色脓性液体引出。引流液培养:肺炎克雷伯菌。经治疗后循环仍不稳定、氧合无改善。随后经胸腹部CT+增强扫描确诊为血肿,实施枸橼酸钠局部抗凝行血液净化治疗。最后该例患者因多脏器功能衰竭抢救无效死亡。结论建议对危重病患者行血液净化治疗过程中若不存在枸橼酸抗凝禁忌证,主张采用局部枸橼酸抗凝,而非肝素或低分子量肝素抗凝。
Objective To retrospectively analyze the diagnosis and treatment of low molecular weight heparin anticoagulation in one case of psoas muscle hematoma in continuous renal replacement therapy and provide evidence for clinical treatment. Methods In December 2015, a case of hemorrhage of the psoas muscle caused by low molecular weight heparin anticoagulation was treated in the Department of Critical Care Medicine of Nanjing Jiangbei Peoples Hospital affiliated to Nantong University. A case of chronic renal insufficiency with continuous renal replacement therapy (CRRT) Basic data for retrospective analysis, summed up their experience in diagnosis and treatment. Results Patients admitted to Shu Su deep anti-infection, phlegm, peritoneal dialysis and other treatment, the symptoms did not improve. Chest and abdomen CT examination showed: liver abscess, to Thailand can be combined with moxifloxacin anti-infection, while intervening in the B-positioning percutaneous liver abscess drainage, see yellow purulent liquid leads. Drainage fluid culture: Klebsiella pneumoniae. Circulation after treatment is still unstable, no improvement in oxygenation. Followed by thoracoabdominal CT enhanced scan confirmed hematoma, the implementation of local sodium citrate anticoagulant blood purification treatment. Finally, the patient died of multiple organ failure due to rescue. Conclusions It is suggested that if citrate anticoagulation contraindication is not used during the blood purification treatment of critically ill patients, it is suggested that local citrate anticoagulation be used instead of heparin or low molecular weight heparin anticoagulation.