简化的局部枸橼酸抗凝在连续性血液净化中的应用

Application of simplified regional citrate anticoagulation in continuous blood purification

目的探讨简化的枸橼酸抗凝在连续性血液净化中的应用。方法回顾性分析40例采用枸橼酸抗凝行连续性血液净化治疗患者的临床资料,置换液采用含钙置换液,静脉端无需泵入钙,监测治疗前后患者的凝血功能、肾功能、电解质及滤器使用寿命。结果 40例患者共行连续性血液净化1 316.30 h,滤器平均使用寿命为45.38 h。治疗后外周血尿素、肌酐较治疗前明显下降,差异有统计学意义(P<0.05);治疗后外周血酸碱度、HCO3-较治疗前升高,差异有统计学意义(P<0.05);治疗前后外周血游离钙离子比较差异无统计学意义(P>0.05)。治疗前后血浆凝血酶原时间、活化的部分凝血活酶时间、血浆凝血酶时间及纤维蛋白原等无明显变化,差异无统计学意义(P>0.05)。所有患者无出血事件发生。结论枸橼酸抗凝安全有效,出血风险小,含钙置换液简化了枸橼酸抗凝的流程。

Objective To explore the application of simplified citrate anticoagulation in continuous blood purification. Methods The clinical data of forty patients with citrate anticoagulation in continuous blood purification therapy was analyzed retrospectively. The displacement liquid contained calcium ion, and venous end without pumping calcium. The blood coagulation function, renal function, electrolyte, and useful life of filter were monitored. Results Forty patients underwent continuous blood purification for 1 316.30 hours ,and the average useful life of filter was 45.38 h. Compared with before treatment,the urea and creatinine after treatment decreased（P 〈0.05） ;the pH value and HCOs - increased（P 〈0. 05）. There was no statistic difference of periphery dissociation Ca2 ＋ before and after treatment （ P 〉 0.05 ）. There was no statistic difference of plasma prothrombin time, activated partial thromboplastin time, blood plasma thrombin time, and fibrinogen before and after treatment （P 〉 0. 05 ）. No bleeding events occured. Conclusion The citrate anticoagulation is safe and effective and the risk of bleeding is small. The displacement liquid containing calcium simplifies the citrate anticoagulation process,it is worthy of promotion.