不同抗凝剂用于血液净化治疗的效果及对患者凝血功能影响研究

Effect of different anticoagulants in the treatment of blood purification and the effect on the coagulation function of the patients

目的探讨不同抗凝剂用于血液净化治疗效果及对患者凝血功能影响。方法选取2016年7月~2017年6月在秦皇岛军工医院重症监护室(ICU)及秦皇岛市第一医院外科重症监护室(ICU)行连续性血液净化(CBP)患者80例,采用随机数表法将患者分为普通肝素抗凝组(n=38)和枸橼酸局部抗凝组(n=42),观察两组治疗前后凝血功能、生化指标等。结果枸橼酸局部抗凝组治疗后尿素氮(BUN)、肌酐(Scr)、丙氨酸氨基转移酶(ALT)和天门冬氨酸氨基转移酶(AST)分别为(10.11±3.02)mmol/L、(155.40±42.39)mmol/L、(67.39±20.04)U/L和(65.51±23.21)U/L,明显低于普通肝素抗凝组,差异有统计学意义(P<0.05);枸橼酸局部抗凝组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和凝血酶时间(TT)分别为(13.20±3.20)s、(40.12±10.21)s和(20.11±8.38)s,明显低于普通肝素抗凝组,差异有统计学意义(P<0.05)。枸橼酸局部抗凝组和普通肝素抗凝组治疗后APACHEⅡ评分比较差异无统计学意义(P>0.05);枸橼酸局部抗凝组滤器使用寿命为(46.92±9.11)h和每日治疗成本为(489.29±67.39)元,明显高于普通肝素抗凝组,差异有统计学意义(P<0.05)。结论肝素和枸橼酸抗凝在CBP中均有较好的效果,其中枸橼酸能明显改善患者凝血、肝肾功能,同时延长滤器使用寿命。

Objective This study investigated the effect of different anticoagulants on blood purification and on the blood coagulation function of the patients. Methods We selected 80 cases of continuous blood purification（CBP） performed in the intensive care unit（ICU） of our hospital from July 2016 to June 2017. These patients were randomly divided into the normal heparin anticoagulant group（n =38） and the local citric acid anticoagulant group（n =42） by random digital table. We observed the blood coagulation function and biochemical indexes and etc before and after treatment. Results The blood urea nitrogen（BUN）, creatinine（Scr）, alanine aminotransferase（ALT） and aspartate aminotransferase（AST） in local citric acid anticoagulation group after treatment were（10.11 ± 3.02）mmol/L,（155.40 ± 42.39）mmol/L,（67.39 ± 20.04）U/L and（65.51 ± 23.21）U/L,were significantly lower than that of normal heparin group（P〈 0.05）;The prothrombin time（PT）,activated partial thromboplastin time（APTT） and thrombin time（TT）in local citric acid anticoagulation group were（13.20 ± 3.20）,s（40.12 ± 10.21）s and（20.11 ± 8.38）s,were significantly lower than the normal heparin group（P 〈0.05）;There was no significant difference in APACHE II score before and after treatment between local citric acid anticoagulant group and normal heparin anticoagulant group（P〉 0.05）;The filter life span and the daily treatment cost of the localcitric acid anticoagulant group were（46.92 ± 9.11）hand（489.29 ± 67.39）yuan,which was significantly higher than that of the normal heparin anticoagulation group（P 〈0.05）. Conclusion Heparin and citric acid anticoagulation are effective in CBP, citric acid can significantly improve coagulation function, liver and kidney function, and prolong filter life.