连续性肾替代治疗对危重患者凝血功能的影响

Effect of Continuous Renal Replacement Therapy on Blood Coagulation in Critically Ⅲ Patients

目的:评价连续性肾替代治疗方法对危重患者的安全性。方法:回顾性统计60例行连续性肾替代治疗患者的病历资料,按治疗累计总时间将患者分为<72h组和>72h组,比较治疗前、后血小板及凝血指标的变化和出血发生率。结果:<72h组在治疗24h后与治疗前比较PLT、纤维蛋白原(FIB)下降,PT、APTT延长(P<0.05);>72h组在24h、72h后各项指标有同样变化,且72h后PLT、FIB下降更多(P<0.01),PT、APTT延长更明显(P<0.05、P<0.01)。>72h组继发出血情况较<72h组严重(P<0.01)。结论:连续性肾替代治疗连续多次治疗后可引起血小板减少、凝血时间延长,出血发生率增加。治疗期间应加强凝血功能监测,治疗次数和时间控制在一定范围,病情改善及时停止治疗,避免增加出血几率。

Objective： To evaluate the safety of continuous renal replacement therapy （CRRT） in critically ill pa tients. Methods： Clinical data of 60 patients received CRRT were retrospectively analyzed. Patients were assigned to 〈72h group and 〉72h group according to cumulative therapy time. Blood coagulation parameters, platelet count （PLT） and the bleeding incidence were compared before and after CRRT. Results： After 24 hours therapy, PLT and Fibrinogen （Fib） decreased, PT and APTT prolonged in 〈72h group（P〈0. 05） ; there were same changes in 〉72h group after 24 hours or on 72 hours, even more obvious decrease in PLT and FIB after 72 hours（P〈0. 01 or P〈0. 05）. The incidence of bleeding was more prominent in 〉72h group than that in 〈72h group（P〈0. 01）. Conclusions： Platelet count may decrease, coagulation time may prolong and the incidence of bleeding may increase after implementing many times of CRRT. Closely monitoring of blood coagulation function should be enhanced during CRRT. It is important to discontinue the therapy in time when there are improvements of patients, so as to reduce bleeding complication.