3%复方枸橼酸钠局部抗凝血液透析在活动性出血肾衰竭患者中的应用

Safety and efficacy of regional citrate anticoagulation in the hemodialysis patients with active bleeding

目的评价3％复方枸橼酸钠局部抗凝血液透析（Regional Citrate Anticoagulation Hemodialysis，RCAHD）在活动性出血肾衰竭患者中应用的安全性。方法9例活动性出血肾衰竭患者12次行RCAHD，检测透析前后肾功能、电解质，并测定透析前后及透析器动、静脉端活化凝血时间（ACT），观察RCAHD的溶质清除效能及对电解质、出凝血指标的影响。结果所有患者均可完成4～4．5h透析，透析器静脉端和静脉壶均有轻微凝血，但不影响跨膜压；透析后肌酐（Cr）、尿素氮（BUN）明显降低（P〈0．01），二氧化碳结合力（CO2-CP）明显升高（P〈0．05）；尿素清除指数（Kt／V）、尿素氮减少率（URR）分别为（1．43±0．26）％和（71．0±5．1）％，达到充分透析标准；动脉端前ACT较静脉端延长约51％，透析前后ACT正常。结论对活动性出血肾衰竭患者行枸橼酸钠局部抗凝血液透析安全、有效。

Objective To investigate the safety and efficacy of regional citrate anticoagulation in hemodialysis patients with active blooding. Methods During 2006.10-2007.5, twelve sessions hemodialysis of nine patients with active bleeding were conducted with regional citrate anticoagulation. The BUN, Cr, and ACT were determined before and after dialysis. In addition, ACT was also measured at the artery and venous end. Results Compared with that of predialysis,the BUN and Cr levels were markedly decreased after dialysis （P 〈0. 001 ）, and enough solute clearance effect,as indicated by Kt/V and URR,was observed. Although it was extended by 51% at the artery end compared with that at the venous end, ACT was within the normal range the after dialysis. Conclusion Regional citrate anticoagulation hemodialysis is a safe and effective method for patients with active bleeding.