高危出血患者血液透析中应用30%枸橼酸钠的观察与护理

Observation and Nursing Care of the Use of 30% Sodium Citrate in Hemodialysis of Patients with High Risk of Hemorrhage

目的探讨高浓度枸橼酸钠用于含钙透析液常规血液透析的安全可行性和护理方法。方法选择37例并发高危出血的维持性血液透析患者,观察应用30%枸橼酸钠抗凝在常规透析中透析的充分性、凝血情况、不良反应及透析前后的血气分析和电解质变化。结果①所有患者均能完成4h～5h常规透析,透析效果充分,平均KT/V=1.31,URR=71%,超滤量(3.2±0.9)kg;②枸橼酸钠抗凝透析前后血HCO3-浓度、离子Ca2+、K+浓度和Na+浓度变化明显(P<0.01,或P<0.05),pH值、CO2结合力(TCO2)均明显上升(P<0.01),PCO2和PO2无明显变化;③活化凝血时间(ACT)和凝血时间试管法无明显变化。结论高浓度枸橼酸钠抗凝用于含钙透析液常规血液透析是安全可行的、护理方法易于掌握,是高危出血患者较为理想的透析方式。

Objective To study the safety and feasibility of high-concentration sodium citrate used in regular hemodialysis with dialysate containing calcium and to explore nursing strategies in this setting.Methods 37 maintenance hemodialysis patients with high risk of hemorrhage were chosen to observe the dialytic efficiency of regular hemodialysis with 30% sodium citrate anticoagulation and its adverse effect.Clotting function,changes of blood gas analysis and serum electrolytes,especially calcium before and after dialysis.Results All pateints with 30% sodium citrate anticoagulation could complete regular hemodialysis for 4 to 5 hours with satisfactory indices:average KT/V 1.31, URR 71% and ultra-filtration (3.2±0.9) kg.The concentrations of serum bicarbonate,ionic calcium,potassium,natrium,blood pH value and TCO_2 before and after dialysis in these patients were significantly different,all restored to normal range.No significant changes were found in PCO_2 and PO_2.Nor was there any change inactive clotting time and clotting time.Conclusion High-concentration sodium citrate anticoagulation is safe,feasible and can be easily handled in regular hemodialysis.It is an ideal dialysate for hemodialysis in patients with high risk of hemorrhage.