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目的针对局部枸橼酸联合小剂量低分子肝素抗凝在连续性肾脏替代治疗中的应用情况实施观察及分析。方法 50例需展开连续性肾脏替代治疗的危重患者,随机分成研究组和参照组,各25例。参照组仅予以低分子肝素抗凝方案,研究组实施局部枸橼酸联合小剂量低分子肝素抗凝方案,观察并对比应用效果。结果研究组中出血或原有出血加重情况为0例(0),少于参照组的6例(24.00%),差异有统计学意义(P<0.05);同时研究组抗凝效果为0~Ⅰ级为2例(8.00%),Ⅱ~Ⅲ级为0例(0),参照组分别为8例(32.00%)、4例(16.00%),两组比较差异有统计学意义(P<0.05)。两组的生化指标比较,透析前后的p H值以及Na+对比,差异无统计学意义(P>0.05);透析后的尿素氮(BUN)以及血肌酐(Scr)水平均明显低于透析前,并且研究组HCO3-高于参照组,总钙低于参照组,差异有统计学意义(P<0.05)。结论采取局部枸橼酸联合小剂量低分子肝素抗凝举措在连续性肾脏替代治疗中的效果较为理想,安全可靠,具备推广实践的价值。
Objective To observe and analyze the application of local citrate combined with low-dose low molecular weight heparin anticoagulation in continuous renal replacement therapy. Methods Fifty critically ill patients who needed continuous renal replacement therapy were randomly divided into study group and reference group, with 25 cases in each group. The reference group only given low molecular weight heparin anticoagulation program, the study group to implement local citrate combined with low-dose low molecular weight heparin anticoagulant program to observe and compare the application effect. Results There were 0 cases (0%) of bleeding or bleeding in study group, less than 6 cases (24.00%) of the reference group, the difference was statistically significant (P <0.05); at the same time, the anticoagulant effect of study group was 0 ~ Grade Ⅰ was 2 cases (8.00%), Grade Ⅱ ~ Ⅲ was 0 cases (0), reference group was 8 cases (32.00%) and 4 cases (16.00%) respectively. There was significant difference between the two groups (P < 0.05). There was no significant difference in biochemical indexes before and after dialysis, p H value before and after dialysis, and Na + contrast (P> 0.05). The levels of BUN and Scr after dialysis were significantly lower than those before dialysis, And HCO3-study group than the reference group, total calcium lower than the reference group, the difference was statistically significant (P <0.05). Conclusion The combination of local citric acid and low-dose low molecular weight heparin anticoagulant therapy in continuous renal replacement therapy is more effective, safe and reliable, and has the value of promoting practice.