不同浓度的枸橼酸盐在常规血液透析中的局部抗凝应用

Regional citrate anticoagulation in different concentration for hemodialysis using a conventional calcium-containing dialysate

目的 本研究通过比较两种不同浓度的枸橼酸盐（30％、4％）抗凝在使用常规透析浓缩液的血液透析中的应用,观察两者的透析效果、抗凝情况及不良反应.方法 选取32例高危出血的维持性血液透析患者,随机分成两组（高浓度枸橼酸盐组15例和低浓度枸橼酸盐组17例）,分别行常规血液透析30例次和32例次,检测透析前后、透析器前后全血活化凝血时间（ACT）、PH值、游离钙（iCa2＋）、钠离子（Na＋）的变化进行比较,同时比较两组平均尿素清除率指数（kt/v）、尿素清除率（URR）、管路凝血情况.结果 两组透析后PH值、Na＋浓度虽较透析前升高（P＜0.05）,但均在正常范围.两组血离子钙在透析后、透析器后均显著下降,但透析器后下降更明显（P＜0.01）.两组透析后、透析器后的ACT略有延长,但变化没有统计学意义（P＞0.05）,枸橼酸钠体外局部抗凝对凝血没有不良影响.对两组透析后ACT、PH值、iCa2＋、Na＋、URR进行比较均无显著性差异.结论 两种浓度的枸橼酸盐在常规血液透析中的局部抗凝是安全、有效、简便,使用高浓度的枸橼酸盐更方便、更经济.

Objective To observe the use of different concentration citrate（30% and 4%） as regional anticoagulation for hemodialysis under conventional dialysis concentrated solution.Methods A total of 32 patients with high risk hemorrhage in need of sustained hemodialysis were randomly divided into two groups （high concentrations of citrate,n =15 and low concentrations of citrate,n =17）.Activated coagulation time（ACT）,serum PH,free calcium（iCa2＋）,serum sodium（Na＋） were observed.Urea clearance rate （URR） and the coagulation in extracorporeal circulation were compared.Results After dialysis,the PH,Na ＋ concentration in both groups increased significantly （P 〈 0.05）,but within the normal range.The iCa2＋ level at different sampling sites （post dialysis,dialyzer outlet） decreased in both groups （P 〈 0.05）,but significantly decreased at dialyzer outlet （P 〈 0.01）.The ACT was not observed statistically significant between both groups （P 〉 0.05）,whereas it was prolonged slightly at post dialysis and dialyzer outlet.The ACT,PH,iCa2 ＋,Na ＋ and URR did not differ significantly after dialysis in both groups.Conclusions Regional citrate anticoagulation for hemodialysis using a conventional calcium-containing dialysate is safe and effective.Using 30% sodium citrate as regional anticoagulation is much easier and more economical as compare with 4% sodium citrate.