两种不同抗凝方法在连续性静脉静脉血液透析滤过中应用的对比研究

A comparative study on anticoagulation with sodium citrate or heparin in continuous venovenous hemodiafiltration

目的观察连续性静脉静脉血液透析滤过(CVVHDF)治疗中常规肝素抗凝与体外枸橼酸钠抗凝两种方法的效果与特点。方法多器官功能不全病人70例,按照随机原则分为两组:A组(体外枸橼酸钠抗凝组)(n=37),B组(常规肝素抗凝组)(n=33)行连续性静脉静脉血液透析滤过治疗,记录治疗前、后的血电解质,酸碱度,凝血指标的变化,管路及血滤器的凝血情况和使用时间,并观察治疗中不良反应。结果治疗过程中两组患者生命体征平稳,电解质、血气指标稳定,肌酐、尿素清除效果明显,超滤可达目标值,A组血滤器的凝血情况和使用时间优于B组,A组体内凝血时间不受影响,A组葡萄糖酸钙用量明显大于B组。结论在CVVHDF体外枸橼酸钠抗凝对比常规肝素抗凝更有效和更安全。

Objective To investigate the anticoagulative effect and specialty of sodium citrate in comparison with heparin in continuous venovenans hemodiafiltration （CVVHDF）. Methods 70 patients with multiple organ failure undergoing CVVHDF were randomly divided into two groups： group A （sodium citrate） （n = 37 ） and group B （heparin） （n = 33 ）. The changes in levels of blood electrolytes, pH value, cruor index and blood coagulation of tube path way and blood filter were recorded. At the same time, side effects were also observed during the therapeutic course. Results Vital signs, levels of serum electrolytes and blood gas markers were kept stable in all patients of these two groups during the ther- apeutic course. Moreover, ideal serum creatinine and urea clearance rate and ultrafiltration rate were obtained in all patients. The coagulation and longevity of blood filter in patients of Group A are better than those of patients in Group B. The cruor index inside body of patients in group A was not significantly prolonged, and the dosage of calcium gluconate in patients of Group A is greater than that of Group B. Conclusion The anticoagulation of sodium citrate in vitro is more effective and reliable than regular anticoagulation of heparin.