局部枸橼酸抗凝法在重症高危出血患者中的应用研究

The Application Research of Regional Citrate Anticoagulation for Severe Patients with High Risk of Bleeding

目的:探讨局部枸橼酸抗凝法(RCA)在重症高危出血患者中的临床效果。方法:选取笔者所在医院2012年5月-2014年5月收治的132例需行连续性肾脏替代治疗的重症高危出血患者,按照随机数字表法将其分为对照组和观察组,每组66例。其中对照组给予无肝素生理盐水冲洗,观察组给予局部枸橼酸抗凝法治疗。观察比较两组患者的血滤器使用时间、治疗前后活化部分凝血活酶时间(APTT)、酸碱平衡和电解质的差异。结果:观察组的血滤器使用时间(43.1±16.2)h明显长于对照组的(11.7±6.6)h,差异有统计学意义(t=14.583,P=0.000)。观察组治疗后的APTT、p H、Ca2+、HCO3-和Na+与治疗前比较差异均无统计学意义(P>0.05)。结论:局部枸橼酸抗凝法用于重症高危出血患者效果确切,不影响内环境的稳定,优于无肝素生理盐水治疗,值得临床推广。

Objective：To investigate the clinical efficacy of regional citrate anticoagulation for patients with high risk of severe bleeding.Method：132 severe patients with high risk of bleeding who need for continuous renal replacement therapy in our hospital from May 2012 to May 2014 were selected,they were divided into the control group and the observation group according to the random number table method,66 cases in each group.The control group was treated with heparin saline solution flush,the observation group was treated with regional citrate anticoagulation therapy.The circuit lifespan using time,activated partial thromboplastin time,acid-base balance and electrolyte before and after treatment of the two groups were observed and compared.Result：The circuit lifespan using time of observation group was（43.1±16.2）h,it was significantly longer than（11.7±6.6）h of control group,the difference was statistically significant（t=14.583,P=0.000）.There were no statistically significant differences in activated partial thromboplastin time,p H,Ca^2＋,HCO3^- and Na^＋ of observation group before and after treatment（P〉0.05）.Conclusion：Regional citrate anticoagulation for severe patients with high risk of bleeding has exact effect without affecting stability of the internal environment.It is better than heparin saline solution flush treatment and worthy of clinical promotion.