枸橼酸钠抗凝在高危出血危险患者血液透析治疗中的应用

Application of Sodium Citrate Anticoagulation in Hemodialysis Patients with High-risk Bleeding

目的探讨枸橼酸钠抗凝在高危出血危险患者血液透析中的应用价值。方法选取2019年6月至2021年11月我院收治的行血液透析治疗的具有高危出血风险患者76例,按随机数字表法将其分为两组,每组各38例。对照组予以减量低分子肝素钙抗凝治疗,试验组采用4%枸橼酸钠抗凝治疗。对比分析两组透析前后电解质、肾功能、凝血功能、血小板变化情况、透析器凝血程度及安全性。结果透析前,两组血钠、血钾、游离钙、血肌酐(SCr)、尿素氮(BUN)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、血小板相比,无统计学差异(P>0.05);透析后,试验组PT、APTT短于对照组,血小板多于对照组,透析器凝血程度优于对照组,有统计学差异(P<0.05);两组血钠、血钾、SCr、BUN、游离钙及不良反应发生率相当,无统计学差异(P>0.05)。结论枸橼酸钠抗凝应用于高危出血危险患者血液透析治疗中,具有良好的抗凝效果,且对患者凝血功能、血小板、电解质影响小,安全可行。

Objective:To explore the application value of sodium citrate anticoagulation in hemodialysis in patients with high-risk bleeding.Methods:A total of 76 patients with high-risk bleeding who underwent hemodialysis treatment in our hospital from June 2019 to November 2021 were selected and divided into two groups according to the random number table method,with 38 cases in each group.The control group was treated with reduced low-molecular-weight heparin calcium,and the test group was treated with 4%sodium citrate anticoagulation.The electrolyte,renal function,coagulation function,platelet changes,the degree of coagulation of the dialyzer and the safety of the two groups before and after dialysis were compared and analyzed.Results:Before dialysis,the two groups compared serum sodium,serum potassium,free calcium,serum creatinine(SCr),urea nitrogen(BUN),prothrombin time(PT),activated partial thrombin time(APTT),and platelets.Statistical difference(P>0.05);After dialysis,the PT and APTT of the test group were shorter than those of the control group,and the number of platelets was more than that of the control group.The coagulation degree of the dialyzer was better than that of the control group.There was a statistical difference(P<0.05);The incidence of sodium,serum potassium,SCr,BUN,free calcium and adverse reactions were similar,and there was no statistical difference(P>0.05).Conclusion:Sodium citrate anticoagulation used in hemodialysis for patients with high-risk bleeding has a good anticoagulant effect,which has little effect on the coagulation function,platelets and electrolytes of patients,with safe and feasible characteristic.