连续性血液净化中枸橼酸抗凝在急性心力衰竭中的应用评价

Evaluation of citrate anticoagulation in continuous blood purification in acute heart failure

目的探讨连续性血液净化中枸橼酸抗凝在急性心力衰竭中的应用情况。方法以本院2014年5月至2016年8月期间收治的105例急性心力衰竭患者作为研究对象。随机分成三组，A组36例（常规药物治疗），B组34例（常规药物治疗联合连续性血液净化治疗-肝素抗凝），C组35例（常规药物治疗联合连续性血液净化治疗-枸橼酸抗凝）。三组治疗前后的生命指标（心率、呼吸、平均动脉压、氧合指数）和心功能指标（LVEF和BNP）比较，B组和C组滤器前后的全血活化凝血时间和滤器使用寿命及滤器抗凝血情况比较。结果c组治疗后的心率、呼吸、平均动脉压、氧合指数、LVEF水平以及BNP水平均优于A组和B组，且B组优于A组，差异有统计学意义（P〈0．05）；滤器后，C组的全血活化凝血时间长于B组，差异有统计学意义（P〈0．05）；C组滤器使用寿命长于B组，滤器抗凝血情况优于B组，差异有统计学意义（P〈0．05）。结论采用连续性血液净化治疗急性心力衰竭患者时采用枸橼酸抗凝能够取得显著的治疗效果。

Objective To study the application of citrate anticoagulation in continuous blood purificationin acute heart failure. Methods 105 patients with acute heart failure treated at our hospital from May, 2014 to August, 2016 were enrolled in this study and were randomly divided into group A （n=36, conventional drug therapy）, group B （n=34, conventional drug therapy combined with continuous blood purification therapy and heparin anticoagulation）, and group C （n=35, conventional drug therapy combined with continuous blood purification therapy and citrate anticoagulation）. The life indicators （heart rate, respiration, mean arterial pressure, and oxygenation index） and heart function indicators （LVEF and BNP） before and after the treatment in these three groups and the whole blood coagulation time, filter life span, and filter anti-coagulation conditions in group B and group C before and after the filter were compared. Results After the treatment, the heart rate, respiration, mean arterial pressure, oxygenation index, LVEF, and BNP level were better in group C than in group A and group B and were so in group B than in group A, with statistical differences （ all P 〈 0.05 ） . After filter, the total blood coagulation time and the filter life span were longer and the filter anti-coagulation was better in group C than in group B, with statistical differences （ all P 〈 0.05 ） . Conclusion Applying continuous blood purification in the treatment of acute heart failure patients with citrate anticoagulant can achieve significant therapeutic effect.