不同抗凝方式对急性肾损伤患者持续性肾脏替代治疗的疗效比较

Comparative Effect of Different Anticoagulation Methods on Continuous Renal Replacement Therapy in Patients with Acute Kidney Injury

目的比较应用局部枸橼酸盐或全身肝素抗凝对急性肾损伤患者接受持续性肾脏替代治疗(CRRT)的疗效。方法按照不同的抗凝方案将62例急性肾损伤患者分为枸橼酸盐组(28例)和肝素组(34例)。分析两组患者血液透析器使用寿命、治疗过程中不良事件和30 d生存状况。结果枸橼酸盐组血液净化器使用寿命为(49±29)h,明显长于肝素组的(28±23)h(P<0.05);出血不良事件发生率为3.57%,明显低于肝素组的23.53%(P<0.05)。枸橼酸组和肝素组患者30 d的生存率分别为61.76%和57.14%,差异无统计学意义(P>0.05)。结论局部枸橼酸盐可广泛应用于急性肾损伤患者CRRT的抗凝治疗,可延长血液净化器使用时间,减少不良事件发生,但对患者短期生存率无明显影响。

Objective To compare the effects of anticoagulation methods with topical use of citrate or systemic use of heparin on continuous renal replacement therapy（ CRRT） in patients with acute kidney injury（ AKI）. Methods Totally 62 patients with AKI were divided into the citrate group（ 28 cases） and the heparin group（ 34 cases） according to different anticoagulant schemes. The life length of the hemofilter,the occurrence of adverse events during the treatment and the 30 d survival conditionsd in the two groups were analyzed.Results The life length of the hemofilter in the citrate group was（ 49 ± 29） h,which was significantly longer than（ 28 ± 23） h in the heparin group（ P〈0. 05）. The incidence rate of adverse events of hemorrhage in the citrate group was 3. 57%, which was significantly lower than 23. 53% in the heparin group（ P〈0. 05）. The 30 d survival rates of the two groups were 61. 76% and 57. 14%,respectively,and the difference was not statistically significant（ P〉0. 05）. Conclusion Topical use of citrate can be widely used in anticoagulation therapy for CRRT in patients with AKI,it has obvious advantages in prolonging the use of hemofilter and reducing adverse events,but it has no obvious advantage on the short-term survival rate of the patients.