心脏外科术后肝功能不全患者枸橼酸抗凝的安全性及有效性研究

Safety and efficacy of citrate anticoagulation continuous post -cardiac surgery patients with liver dysfunction

目的 研究心脏外科术后肝功能不全患者枸橼酸抗凝血液滤过的安全性及有效性。方法 回顾性分析2012-02~2017-10阜外医院心脏术后行血液滤过治疗的患者数据。肝功能（Child-Turcotte-Pugh, CTP）评分〉4分诊断为肝功能不全，共102例患者符合标准。按抗凝方式不同分为枸橼酸组、肝素组和无抗凝组，对三组血气分析，治疗期间胸液量、输血量，治疗后肌酐值等进行比较分析。结果 三组患者血液滤过治疗前基础情况差异均无统计学意义（P＞0.05）。治疗后6 h血气指标pH值、全血剩余碱BE、乳酸及血清钙离子浓度差异均无统计学意义（P＞0.05）。枸橼酸组治疗后体内总钙高于肝素组和无抗凝组，差异有统计学意义（P=0.025）。肝素组血液滤过治疗期间胸液量（819±314）mL，枸橼酸组和无抗凝组血液滤过治疗期间胸液量为（477±268）mL和（414±335）mL。肝素组与枸橼酸组及无抗凝组比较差异有统计学意义（P=0.027和P=0.021）。枸橼酸组滤器寿命（54.050±2.744）h、肝素组为（49.110±1.462）h、无抗凝组（25.690±2.577 ）h，三组比较差异有统计学意义（Log- rank检验， χ2=44.11，P＜0.001）。结论 心脏外科术后肝功能不全患者枸橼酸抗凝增加滤器使用寿命，不增加术后出血量，不引起内环境失衡及电解质紊乱，安全有效。

Objective To evaluate the safety and efficacy of citrate anticoagulant continuous post-cardiac surgery patients with liver dysfunction. Methods The data of post - cardiac surgery patients were analyzed retrospectively in Fuwai Hospital from February 2012 to October 2017. Liver dysfunction was defined as Child- Turcotte- Pugh （CTP） score 〉 4. A total of 102 patients met the criteria. The patients were divided into citrate group, heparin group and no anticoagulant group according to their different anticoagulant methods. Results There was no statistical difference between the three groups at baseline. The pH value, BE, lactic acid and serum calcium concentration were not statistically different 6 hours after renal replacement therapies. The total calcium in the citrate group was higher（ P = 0.025）. In the heparin group, the pleural drainage was（819 ±314）mL during the blood filtration treatment, compared with （ 477 ±268 ） mL and （ 414 ±335 ） mL in the citrate and non anticoagulant groups. There was significant difference between the heparin anticoagulant group and the citrate group and the anticoagulant group （ P = 0. 027 and P = 0. 021 ）. The citrate group filter life was （ 54. 050 ±2. 744） h, heparin group was （49.110 ±1. 462 ） h, no anticoagulant group （ 25. 690 ±2. 577 ） h, thedifference between the three groups was statistically significant （ Log - rank test, χ2 = 44. 11, P 〈 0. 001 ）. Conclusion Citrate anticoagulation can increase the life of filter in patients with liver dysfunction after cardiac surgery, without increasing the amount of bleeding after operation or causing internal environmental imbalance and electrolyte disturbance.