局部枸橼酸抗凝血液透析在高危出血患者中的应用

Regional citrate anticoagulation for hemodialysis in patients at risk for bleeding

目的 研究解决高危出血患者血液透析的抗凝方法局部枸橼酸抗凝(RCA)在临床的应用和疗效。方法 采用1.6mol/L的枸橼酸钠、空心纤维透析器和普通合碳酸氢盐透析液,观察RCA透析对患者出血、体外循环凝血、血游离钙(Ca^(2+))、总钙(Ca)、K^+、Na^+、pH、HCO_3^-、Scr、BUN及血清枸橼酸浓度的影响。结果 23例急、慢性肾衰患者共行72例次RCA透析,其中17例高危出血患者64例次,未见有引起或加重出血者。透析器及管路未见发生严重凝血现象,无明显电解质、酸碱平衡紊乱症状。透析后血清枸橼酸浓度为0.9324±0.3623mmol/L。结论 RCA透析安全、有效、简便,尤其适用于高危出血患者。

Objective To solve the hemodialysis in patients at risk for bleeding. Methods A 1.6 mol/L trisodium citrate solution, a standard calcium-containing bicarbonate dialysate and a standard hollow fiber capillary dialyzer were used. Results 72 dialysis were performed successfully with this technique on 6 stable and 17 high bleeding risk patients. Systemic anticoagulation didn't occur as a result of any dialysis procedure, and in no instance bleeding was observed. No severe dialyzer clotting was observed. There was a significant decline in whole blood ionized calcium during citrate dialysis (0.981±0.11 vs 0.907 ±0.12 mmol/L, P < 0.01) , but was still in the normal levels. There were significant increasements in serum HCOf and pH during citrate dialysis, but no patient developed obvious metabolic alkalosis symptoms. In addition, absence of citrate intoxication by serial measurements of serum citrate levels was documented. Conclusion Regional citrate anticoagulation is a safe, effective and simple method of performing hemodialysis in patients with chronic or acute renal failure at risk for bleeding.