局部枸橼酸抗凝在心脏术后合并急性肾损伤进行连续性肾脏替代治疗中的应用

Application of regional citrate anticoagulation on continuous renal replacement treating patients with acute kidney injury after cardiac surgery

目的探讨局部枸橼酸抗凝在心脏术后合并急性肾损伤患者进行连续性肾脏替代治疗（CRRT）中的有效性和安全性。方法收集2012年7月~2014年11月柳州市人民医院心脏术后合并急性肾损伤进行床旁连续性肾脏替代治疗的患者42例。将患者分为局部枸橼酸抗凝组（RCA组,21例）和无抗凝剂组（21例）。对两组患者治疗前后血尿素氮、肌酐及滤器寿命进行比较;对两组患者组治疗结束后血液酸碱度（p H）、钠离子（Na＋）、游离钙离子（i Ca2＋）、镁离子（Mg2＋）及凝血功能进行比较。结果 RCA组滤器寿命[（20.8±2.6）h]明显长于无抗凝剂组[（11.0±1.6）h]（P〈0.05）;两组CRRT均能有效降低血尿素氮及血肌酐水平（P〈0.05）,但RCA组溶质清除效果优于无抗凝剂组（P〈0.05）;两组患者治疗后凝血酶原时间（PT）、活化的部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、凝血酶时间（TT）比较,差异无统计学意义（P〉0.05）,但RCA组血小板较无抗凝剂组增高（P〈0.05）;两组患者治疗后i Ca2＋、Mg2＋、p H值差异无统计学意义（P〉0.05）。结论局部枸橼酸抗凝应用于心脏术后并急性肾损伤患者的连续性肾脏替代治疗是一种安全有效的方法。

Objective To explore the effect and safety of regional citrate anticoagulation（RCA） on continuous renal replacement therapy（CRRT） for patients with acute kidney injury after cardiac surgery.Methods From July 2012 to November 2014,in the People＇s Hospital of Liuzhou City,42 patients with acute kidney injury after cardiac surgery in CRRT were selected and divided into RCA group（21 cases） and no anticoagulant group（21 cases）.Blood urea nitrogen,creatinine and filter life in two groups were compared before and after the treatment.Potential of hydrogen（p H）,Na＋,i Ca2＋,Mg2＋and coagulation function in two groups were compared after the treatment.Results The filter life in RCA group [（20.8±2.6） h] was longer than that in no anticoagulant group [（11.0±1.6） h]（P〈0.05）.The blood urea nitrogen and creatilline were reduced in both groups（P〈0.05）,the decrease of blood urea nitrogen and creatinine in RCA were significantly better than those in no anticoagulant group（P〈0.05）.Compared with no anticoagulant group,there was no statistically significant difference of the PT,APTT,TT and FIB in RCA group（P〉0.05）,but the platelet was increased（P〈0.05）.There was no statistically significant difference in the i Ca2＋,Mg2＋,p H between two groups after the treatment（P〉0.05）.Conclusion Regional citrate anticoagulation is a safer and more effective method on continuous renal replacement treating patients with acute kidney injury after cardiac surgery.