局部枸橼酸钠抗凝在持续低效血液透析滤过抢救蜂蛰伤后多脏器功能障碍综合征患者中的应用

Application of regional citrate anticoagulation in sustained low-efficiency diafiltration for patients with multiple organ dysfunction syndrome following wasp sting

目的 评价局部枸橼酸钠抗凝（RCA）在持续低效血液透析滤过（SLEDF）抢救蜂蛰伤后多脏器功能障碍综合征（MODS）患者中的应用.方法 将40例蜂蛰伤后MODS并接受SLEDF治疗的患者随机分为无肝素组和枸橼酸钠组.比较两组患者治疗前和治疗第4天急性生理学与慢性健康状况评分（APACHE）Ⅱ、MODS评分及血小板数目.观察两组患者血管通路及滤器凝血情况,比较两组患者每次SLEDF治疗前后血钠、凝血酶原时间（PT）、活化部分凝血酶时间（APTT）、pH值和剩余碱（BE）,枸橼酸钠组患者观察治疗前、治疗2、4、6小时和治疗后患者体内及管路游离钙离子（iCa^2＋）水平.结果 在治疗前以及治疗第4天,两组APACHEⅡ、MODS评分和血小板计数比较差异无统计学意义（P＞0.05）;枸橼酸钠组血管通路及滤器凝血程度均低于无肝素组（P＜0.05）.SLEDF治疗后两组患者血钠、PT和APTT与治疗前比较差异无统计学意义（P＞0.05）,而pH和BE均较治疗前升高（P＜0.05）,但两组间比较,差异无统计学意义（P＞0.05）.枸橼酸钠组患者治疗过程中体内及管路iCa^2＋浓度在不同时间点比较差异无统计学意义（P＞0.05）.结论 在SLEDF抢救蜂蛰伤后MODS患者时应用RCA安全有效.

Objective To evaluate the safety and efficacy of regional citrate antieoagulation （RCA） in sustained low-efficiency diafiltration（SLEDF） for patients with multiple organ dysfunction syn- drome（MODS） following wasp sting. Methods Forty patients with wasp sting induced-MODS, received treatment of SLEDF, were randomly divided into control group（ anticoagulation without heparin） and RCA group with 20 patients in each group. Scores of acute physiology and chronic health evaluation（APACHE） II and MODS and blood platelet count were compared between two groups before treatment and on 4th day after treatment. Blood coagulation of tube pathways and blood filters were recorded. Blood levels of sodi- um, prothrombin time （ PT）, activated partial thrombin time （ APTT） , pH and base excess （ BE ） were de- tected before and after SLEDF, and ionised calcium （ iCa^2＋ ） concentration in peripheral blood and tube pathways were measured during SLEDF. Results There were no statistical differences of scores of APACHE 11 and MODS and blood platelct count between two groups before treatment and on 4th day after treatment （P 〉 0.05 ） respectively. Degree of blood coagulation of tube pathways and blood filters were more severe in RCA group than in control group （P 〈 0.05 ） respectively. Compared to before treatment, blood levels of sodium, PT and APTT were similar after SLEDF in two groups （P 〉 0.05 ） respectively, blood levels of pH and BE were increased（P 〈 0.05 ） respectively, and there existed no statistical differ- ences of blood levels of pH and BE between two groups after SLEDF. During SLEDF,iCa^2＋ concentration were similar at five time-points in both peripheral blood and tube pathways （ P 〉 0.05 ）. Conclusion During SLEDF for patients with MODS following wasp sting, RCA is safe and effective.