枸橼酸钠抗凝在连续性血浆吸附治疗中的应用

Sodium citrate anticoagulation in continuous plasma adsorption treatment of clinical research

目的探讨枸橼酸钠抗凝在连续性血浆吸附治疗闭路循环中的抗凝方法及效果。方法纳入行连续性血浆吸附治疗的急性药物中毒患者156例次随机（随机数字法）分为两组，每组78例次，分别采取低分子肝素（A组）、枸橼酸钠（B组）抗凝。对比分析两组在治疗开始后30min、3h、6h患者的滤前压、跨膜压、滤压降，同时比较两组治疗开始前10min，治疗开始后3h、6h血小板、凝血活酶时间，体内静脉游离Ca^2＋、Na^＋、HCO3^-和24h内出血情况。结果两组患者在性别、年龄、临床诊断、血液净化时间比较差异均无统计学意义（P〉0．05）；两组治疗开始后30min、3h、6h患者滤前压、跨膜压、滤压降比较差异均无统计学意义（P〉0．05）；治疗后低分子肝素组部分凝血活酶时间较枸橼酸钠组明显延长（P〈0．01）；两组治疗后血小板、HCO3^-、静脉游离Ca2＋和Na^＋差异均无统计学意义（P〉0．05）。结论在连续性血浆吸附治疗过程中应用枸橼酸钠抗凝具备临床可行性、安全性。

Objective Explore the sodium citrate anticoagulation in the continuity of plasma adsorption closed-circuit circulation of anticoagulation therapy method and effect. Methods Line into the continuity of plasma adsorption treatment of 156 cases of acute drug poisoning patients were randomly（random number） divided into two groups, 78 cases in each group, respectively adopt low molecular heparin （group A）, sodium citrate anticoagulation （group B）. Contrast analysis of two groups after the therapy began 30 min, 3 h, 6 h before the filter in patients with pressure, transmembrane pressure, pressure drop, at the same time to compare two groups of 10 rain before the start of treatment, after treatment began to 3 h, 6 h platelet, coagulation time live enzymes, vein in the body of free Ca^2＋, Na^＋ and HCO3^- 24 h and internal bleeding. Results Two groups in gender, age, clinical diagnosis, blood purification time comparative differences had no statistical significance （P〉0.05）;Two groups of 30 min after the start of treatment, 3 h, 6 h patients before pressure, transmembrane pressure, filter pressure drop compared differences were no statistical significance （P〉0.05）; Part of coagulation treatment after low molecular heparin group live enzymes the sodium citrate group significantly prolonged （P〈0.01）; Platelets, HCO3^- the two groups after treatment, intravenous free Ca^2＋ and Na^＋ differences had no statistical significance （P〉0.05）. Conclusions In the continuous plasma adsorption treatment process using sodium citrate anticoagulation with clinical feasibility, safety.