局部枸橼酸抗凝和肝素抗凝在危重病人血液滤过治疗中的比较

Comparison of the clinical effect between regional citrate anticoagulation and heparin anticoagulation in severe patients treated with blood filtration

目的:分析局部枸橼酸抗凝(RCA)和普通肝素抗凝在危急重症病人行持续性静脉-静脉血液滤过治疗(CVVH)中的临床效果。方法:回顾性分析45例行CVVH治疗的危急重症病人临床资料,根据抗凝方法不同分为RCA-CVVH组(RCA组,25例)和普通肝素抗凝CVVH组(肝素组,20例),比较2组病人治疗前后凝血功能、内环境、肾功能、出血并发症发生情况以及滤器寿命方面的差异。结果:治疗后,RCA组病人活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)时间较治疗前无明显变化(P>0.05),尿素氮(BUN)、血肌酐(Cr)水平明显降低(P<0.01);肝素组病人APTT与PT时间较治疗前延长(P<0.01),BUN和Cr水平较治疗前均明显下降(P<0.01)。RCA组Na^+、Ca^(2+)水平较治疗前下降(P<0.05),HCO_3^-和p H值无明显变化(P>0.05);而肝素组治疗前后Na^+、Ca^(2+)、HCO_3^-和p H值均无明显变化(P>0.05)。RCA组继发出血1例(4%),低于肝素组的3例(15%)(P<0.05);RCA组平均滤器使用寿命为(35.26±7.60)h,长于肝素组的(20.75±5.3)h(P<0.01)。结论:RCA具有与肝素抗凝病人相似的滤过效果,而且对凝血功能影响较小,不增加危急重症病人出血风险,还能延长滤器的使用寿命,具有更高的安全性和实用性。

Objective：To compare the clinical effects between regional citrate anticoagulation（RCA） and heparin anticoagulation in severe patients treated with continuous venous-venous hemofiltration（ CVVH） . Methods：The clinical data of 45 severe patients treated with CVVH were retrospectively analyzed. The patients were divided into the RCA-CVVH group（ RCA group,25 cases） and heparin anticoagulation CVVH group （ heparin group, 20 cases ） according to the anticoagulation method. The differences of the coagulant function,internal environment,renal function,bleeding complication and filter longevity before and after treatment between two groups were compared. Results：The differences of the activated partial thromboplastin time（ APTT） and prothrombin time（ PT） in RCA-CVVH group between before and after treatment were not statistically significant（P〉0. 05）,and the levels of the Cr and BUN in RCA-CVVH group significantly decreased after treatment（P 〈0. 01）. Compared before treatment,the APTT and PT in heparin-CVVH group prolonged after treatment（P〈0. 01）,and the levels of the Cr and BUN in heparin-CVVH group significantly decreased after treatment （P〈0. 01）. Compared before treatment,the levels of Na＋ and Ca2 ＋ in RCA group decreased after treatment（P〈0. 01）,the changes of the level of HCO3-and pH value in RCA group were not obvious after treatment（P〉0. 05）. Compared before treatment,the changes of the levels of Na＋,Ca2 ＋ and HCO3-,and pH value in heparin group were not obvious after treatment（P〉0. 05）. The secondary hemorrhage in RCA group（1 cases,4%） was lower than that in heparin group（3 cases,15%）（P〈0. 05）. The filter longevity in RCA group[（35.26＆#177;7.60）h]waslongerthanthatinheparingroup[（20.75＆#177;5.3）h]（P〈0.01）.Conclusions：Thefiltrationeffectof RCA-CVVH is similar to heparin,which is less effect on the coagulation function,does not increase the bleeding risk in severe patients, can prolong the filter longevity,and has better security and practicability.