枸橼酸钠置换液对凝血功能影响的实验研究

Experimental researches on effects of sodium citrate substitution fluid on blood coagulation function

目的探讨含枸橼酸钠的置换液在血液滤过中对凝血功能的影响，以及其使用的安全性。方法健康犬12只分为2组：枸橼酸钠组：使用含1．5mmol／L枸橼酸钠的置换液，在血滤管路静脉端持续补钙；肝素组：使用低分子肝素（20U／kg·h）持续泵入；记录血液滤过前、血液滤过后每2小时的血肌酐、尿素、血气分析、凝血功能（PT、PT％、PT／R、PTINR、APTT、AT3％及Fbg等）的变化。结果两组血浆的肌酐、尿素、血气分析等结果两组无明显差异（P〉0．05），血滤滤治疗过程中均未有管路和血滤器堵塞现象；枸橼酸钠组的实验犬体内的PT、PT％、PT／R、PTINR、APTT、AT3％均不延长，纤维蛋白原浓度（Fbg）没有明显下降；与之比较，肝素组体内的PT、PTINR、APTT均有延长（P〈0．01）。结论枸橼酸盐置换液应用血液滤过治疗时，不会对体内凝血功能及内环境产生不良影响，抗凝效果良好。

Objective To investigate the anticoagulative effect and reliability of sodium citrate substitution fluid during hemofihration process. Methods 12 healthy hybridize dogs were randomly divided into experimental group and control group. Sodium citrate substitution calcium glyconate （1.5mmol/L） was continuously supplied during the treatment periods in the treatment group, and control group was given low molecular heparin （20U/kg.h）. Each group was given hemofiltration, and the blood gas analysis, serum creatinine, blood urea nitrogen （BUN）, electrolyte, prothrombin time （PT）, PT%, PT/R, PT INR, activated partial thromboplastin time（APTT）, AT3%, thromboplastin time （TT） and Fbg were examined before hemofiltration and after hemofiltration every two hours, Results The results of blood gas analysis, serum creatinine, blood urea nitrogen （BUN） and so on between two groups no significantly difference during the therapeutic periods （P〉0.05）. Compared with control group, plasma PT, PT INR and APTI＇ in treatment group were significant decrease （P〈 0.01）. Conclusion Therapeutic effects and improved hemorrhagic tendency were achieved in using sodium citrate substitution fluid during hemofiltration.