四种抗凝方法对连续静脉-静脉血液滤过术中滤器寿命的影响及安全性被引量：9

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摘要目的探讨低分子肝素(LMWH)、局部枸橼酸盐、肝素以及无肝素抗凝法对连续静脉-静脉血液滤过(CVVH)中滤器寿命的影响及安全性。方法选择肾功能衰竭患者56例,进行床旁CVVH治疗75例次,按抗凝方式分为无肝素抗凝组(A组11例次)、低分子肝素组(B组16例次)、局部枸橼酸盐组(C组24例次)、肝素组(D组24例次),比较各组滤器寿命、治疗停止原因、相关的代谢异常和出血并发症。结果四组中,C组滤器使用寿命45.7 h明显长于A组的21.7 h、B组的34.7 h、D组的40.2 h(P均<0.01)。Kaplan-Meier生存曲线显示四组抗凝方法的滤器寿命比较,P<0.01;C、D组长于A、B组(P均<0.01)。四组治疗中均未出现严重酸碱平衡电解质紊乱,新发出血事件差异无统计学意义(P均>0.05)。结论局部枸橼酸盐抗凝与低分子肝素抗凝、肝素抗凝、无肝素抗凝法相比能明显延长滤器使用寿命,并且不增加严重代谢紊乱及出血风险。

作者洪欢彭松张琳

机构地区安徽医科大学第三附属医院

出处《山东医药》 CAS 北大核心 2016年第29期88-90,共3页 Shandong Medical Journal

关键词连续静脉-静脉血液滤过抗凝方法肝素低分子肝素枸橼酸盐

分类号 R969.4 [医药卫生—药理学]

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参考文献11

1Honore PM, Jacobs R, Joannes-Boyau O, et al. Septic AKI in ICU patients, diagnosis, pathophysiology, and treatment type, dosing, and timing: a comprehensive review of recent and future develop- ments[ J]. Ann Intensive Care, 2011,1 ( 1 ) :32.
2Kellum JA, Mehta RL, Angus DC, et al. The first international consensus conference on continuous renal replacement therapy [ J ]. Kidney Int, 2002,62 (5) : 1855-1863.
3Ronco C, Bellomo R, Homel P, et al. Effects of different does in continuous veno-venous haemo-filtration on outcome of acute renal failure : a prospective randomised trial [ J ]. Lancet, 2000, 356 (9223) :26-30.
4Bellomo R, Teede H, Boyce N. Anticoagulant regimens in acute continuous hemodiafiltration: a comparative study [ J ]. Intensive Care Med, 1993,19(6) :329-332.
5Uchino S, Fealy N, Baldwin I, et al. Continuous is not continu- ous: the incidence and impact of circuit "down time" on uraemic control during continuous veno-venous haemofihration [ J ]. Inten- sive Care Med, 2003,29(4) :575-578.
6Schiffl H, Lang SM, Fisher R, et al. Daily hemodialysis and the outcome of acute renal failure[J]. N Engl J Med, 2002,346(5) : 305 -310.
7张凯悦,徐斌,吴丛业,刘志红,季大玺,龚德华.局部枸橼酸联合小剂量低分子肝素抗凝在连续性肾脏替代治疗中的应用[J].肾脏病与透析肾移植杂志,2012,21(4):311-316. 被引量：30
8Dhondt A, Vanholder R, Tielemans C, et al. Effect of regional cit- rate anticoagulation on leuko- penia, of leukocyte surface molecules complement activation, and expression during hemodialysis with unmodified cellulose membrane [ J ]. Nephron, 2000,85 (4) : 334- 342.
9Liu C, Mao Z, Kang H, et al. Regional citrate versus heparin anti- coagulation for continuous renal replacement therapy in critically il- lpatients: a meta-analysis with trial sequential analysis of random- ized controlled trials [ J ]. Crit Care, 2016,20 ( 1 ) : 144.
10Tovey L, Dickie H, Gangi S, et al. Beyond the randomized clini- cal trial : citrate for continuous renal replacement therapy in clinical practice[J]. Nephron Clin Pract, 2013,124(1-2) :119-123.

二级参考文献15

1Kellum JA, Mehta RL, Angus DC, et al. The first international consensus conference on continuous renal replacement therapy. Kidney Int,2002,62(5 ) : 1855 - 1863.
2Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure : a prospective randomised trial. Lancet, 2000, 356(9223) :26 - 30.
3Uchino S, Fealy N, Baldwin I, et al. Continuous is not continuous : the incidence and impact of circuit " down-time" on uraemic control during continuous veno-venous haemofiltration. Intensive Care Med, 2003,29(4) :575 -578.
4Schiffl H, Lang SM, Fischer R, et al. Daily hemodialysis and the outcome of acute renal failure. N Engl J Med, 2002, 346 (5) :305 - 310.
5Dhondt A,Vanholder R, Tielemans C, et al. Effect of regional citrate anticoagulation on leukopenia, complement activation, and expression of leukocyte surface molecules during hemodialysis with unmodified cellulose membrane. Nephron, 2000,85 (4) : 334 - 342.
6Morgera S, Schneider M, Slowinski T, et al. A safe citrate anticoagulation protocol with variable treatment efficacy and excellent control of the acid-base status. Crit Care Med, 2009, 37 (6) :2018 -2024.
7Hetzel GR, Schmitz M, Wissing H, et al. Regional citrate versus systemic heparin for anticoagulation in critically ill patients on continuous venovenous haemofiltration: a prospective randomized muhicentre trial. Nephrol Dial Transplant ,2011,26 ( 1 ) :232 - 239.
8Kutsogiannis D J, Gibney RT, Stollery D, el at. Regional citrate versus systemic heparin anticoagulation for continuous renal replacement in critically ill patients, kidney International, 2005, 67 (6) :2361 -2367.
9Bagshaw SM, Laupland KB, Boiteau PJ, et al. Is regional citratesuperior to systemic heparin anticoagulation for continuous renal replacement therapy? A prospective observational study in an adult regional critical care system. J Crit Care,2005,20(2) :155 -161.
10Uchino S, Benomo R, Morimatsu H, et al. Continuous renal replacement therapy:a worldwide practice survey. The beginning and ending supportive therapy for the kidney (B. E. S. T. kidney ) investigators. Intensive Care Med ,2007,33 ( 9 ) : 1563 - 1570.