不同抗凝方式在连续性静脉-静脉血液滤过治疗脓毒症时对患者的影响

Effect of Different Anticoagulation Methods on Patients with Continuous Veno-venous Hemofiltration for Sepsis

目的:探讨不同抗凝方式在连续性静脉-静脉血液滤过(CVVH)治疗脓毒症时对患者的影响。方法:选择CVVH治疗的脓毒症患者96例,根据治疗方法差异分为观察组(n=48)与对照组(n=48)。其中观察组给予枸橼酸钠抗凝,对照组给予低分子肝素钠抗凝。比较两组患者治疗前后、C-反应蛋白(CRP)水平、降钙素原(PCT)水平和滤器使用时间、急性生理与慢性健康Ⅱ(APACHEⅡ)评分,同时比较两组患者CVVH治疗后出血事件的发生率。结果:观察组患者滤器使用时间明显高于对照组;治疗72h后,观察组APACHEⅡ评分显著低于对照组,CRP及PCT水平显著低于对照组;观察组出血事件的发生率显著低于对照组(0 vs 16.67%),差异均显著(P<0.05)。结论:脓毒症患者CVVH治疗时采用枸橼酸钠具有良好的抗凝作用,能够延长管路及滤器使用寿命,改善患者的炎症状态,且应用安全。

Objective： To investigate the effect of different anticoagulation methods on patients treated with CVVH in sepsis. Methods： 96 patients with sepsis treated with CVVH were divided into observation group （n=48, was given sodium citrate anticoagulation） and control group （n=48, was given low molecular weight heparin sodium anticoagulation）. The levels of CRP, PCT, filter use, and APACHE II scores before and after treatment were compared between the two groups. At the same time, the incidence of bleeding after hemofiltration was compared between the two groups. Results： The time of use of the filter in the observation group was higher than that of the control group （P〈0.05）; after 72h of treatment, the APACHE II score, the CRP and PCT levels of the observation group was lower than that of the control group （P〈0.05）. The incidence of bleeding in the observation group was significantly lower than that in the control group （0.00% vs 16.67%, P〈0.05）. Conclusion： Sodium citrate has a good anticoagulant effect in hemofiltration treatment of sepsis patients, which can prolong the service life of pipelines and filters, improve the patient＇s inflammatory status, and provide safety.