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目的探讨局部枸橼酸抗凝在高危出血患者行连续肾脏替代疗法(CRRT)中应用的安全性及有效性。方法选取2013—2014年徐州市中心医院收治的肾功能不全患者22例,CRRT模式CVVHDF,均采用局部枸橼酸抗凝方案,维持滤器后二价钙离子(i Ca2+)浓度0.25~0.40mmol/L,10%葡萄糖酸钙注射液单独经外周或中心静脉通路持续泵入,维持全身血液i Ca2+浓度0.9~1.0mmol/L。观察0、2、4、8h及治疗结束时滤器后血浆凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、i Ca2+;0、2、4、8h及治疗结束时体内血尿素氮(BUN)、肌酐(Cr)、PT、APTT、i Ca2+,钠离子(Na+)、钙离子(Ca2+)、碳酸氢根(HCO-3)水平、p H值及滤器使用时间。结果治疗4h、8h、结束时BUN、Cr水平低于0h时,差异有统计学意义(P<0.05)。22例患者共进行22次CRRT,治疗总时间为659h(17~62h),平均滤器使用时间为(30.0±11.5)h。0、2、4、8h及治疗结束时患者滤器后PT、APTT均长于体内,差异有统计学意义(P<0.05);体内、滤器后PT、APTT不同时间点比较,差异无统计学意义(P>0.05)。0、2、4、8h及治疗结束时患者滤器后i Ca2+水平低于体内,差异有统计学意义(P<0.05);体内、滤器后不同时间点i Ca2+水平比较,差异无统计学意义(P>0.05)。0、2、4、8h及治疗结束时患者p H值、HCO-3、Ca2+、Na+水平比较,差异无统计学意义(P>0.05)。结论枸橼酸抗凝不影响患者全身凝血功能,不增加出血风险,可保证血液净化安全有效进行,在出血及存在高危出血风险的危重患者行CRRT中的应用安全有效。
Objective To investigate the safety and efficacy of local citrate anticoagulation in the treatment of patients with high-risk hemorrhage undergoing continuous renal replacement therapy (CRRT). Methods Twenty-two patients with renal dysfunction admitted to Xuzhou Central Hospital from 2013 to 2014 were enrolled in this study. The local citrate anticoagulation strategy was used to maintain CRP-induced CVCHR. The iCa2 + concentration was maintained at 0.25-0.40 mmol / L, 10% calcium gluconate injection continuously pumped through the peripheral or central venous access to maintain systemic blood i Ca2 concentration 0.9 ~ 1.0mmol / L. The levels of plasma prothrombin time (PT), activated partial prothrombin time (APTT), i Ca2 + at 0, 2, 4, 8h and at the end of treatment were observed; BUN, Cr, PT, APTT, i Ca2 +, Na +, Ca2 +, HCO3-, p H and filter usage time. Results At 4h, 8h, the levels of BUN and Cr were lower than 0h at the end of treatment (P <0.05). Twenty-two patients underwent 22 CRRTs, with a total duration of 659h (17 to 62h) and an average filter duration of (30.0 ± 11.5) h. At 0, 2, 4, and 8h after treatment, the PT and APTT of the filter in the patients were longer than that in the body (P <0.05). There was no significant difference in PT and APTT between the two groups P> 0.05). At 0, 2, 4, 8h and after treatment, the level of i Ca2 + was lower in the patients with the filter than in the body (P <0.05). There was no significant difference in i Ca2 + level at different time points in vivo and after the filter P> 0.05). There was no significant difference in p H value, HCO-3, Ca2 +, Na + levels at 0, 2, 4, 8h and at the end of treatment (P> 0.05). Conclusion Citrate anticoagulation does not affect the systemic coagulation function in patients without increasing the risk of bleeding, which can ensure the safe and effective blood purification. It is safe and effective in the application of CRRT in patients with hemorrhage and high risk of bleeding.