枸橼酸和肝素用于合并出血风险急性肾损伤患者持续肾脏替代治疗体外抗凝比较

Comparison of Regional Citrate Anticoagulation and Regional Heparin Anticoagulation in Acute Kidney Injury Patients with Bleeding Risk Undergoing CRRT

目的通过回顾性分析,比较合并出血风险的急性肾损伤(AKI)患者行持续肾脏替代治疗(CRRT)应用体外枸橼酸抗凝和体外肝素抗凝法的优缺点,探讨重症AKI患者CRRT时最佳抗凝方式及护理注意事项。方法将96例存在凝血功能紊乱或出血风险的AKI患者分为体外枸橼酸组50例和体外肝素组46例,对比分析两组透析前后活化部分凝血活酶时间(APTT)、游离钙、p H值、碳酸氢根、钠离子、两组血滤器使用时间及出血等不良事件发生率。结果体外枸橼酸组高钠血症、代谢性碱中毒及转氨酶升高发生率分别为2.3%,6.1%,1.9%,体外肝素组分别为1.6%,0.9%,1.6%;体外枸橼酸组使用血滤器(70.0±5.3)h,体外肝素组为(48.0±2.7)h(P<0.05),体外枸橼酸组出血不良事件发生率3.8%,体外肝素组为13.0%(P<0.05)。结论对于存在凝血功能紊乱或出血风险的AKI患者进行CRRT时,体外枸橼酸抗凝法更安全有效,值得推广。

Objective To compare and explore the efficacy of regional citrate anticoagulation therapy and regional heparin anticoagulation therapy in continuous renal replacement therapy （ CRRT） of acute kidney injury （ AKI） patients with risk of bleeding by an retrospective study. Methods A total of 96 AKI patients with risk of bleeding were collected retrospectively and treated with CRRT. All the patients were divided into two groups：regional citrate group （ n=50） and regional heparin group （ n=46） . APTT, level of Ca^2＋, pH value, levels of HCO-3 and Na^＋, time of blood filter using and incidence of adverse events were compared between the two groups. Results Percentage of hypernatremia, metabolic alkalosis and elevation of transaminase in regional citrate group were 2.3%, 6.1%, 1.9%, respectively, those in the regional heparin group were 1.6%, 0.9%, 1.6%, respectively. The time of blood filter using in regional citrate group and regional heparin group were （70.0±5.3） h and （48.0±2.7） h, respectively （P〈0.05）. Incidence of bleeding event in regional citrate group and regional heparin group were 3.8% and 13.0%, respectively （P〈0.05）. Conclusion In patients with coagulation disorders or bleeding risk undergoing CRRT, regional citrate anticoagulation therapy is safer and more effective, and worthy of promotion.