枸橼酸钠抗凝在心脏术后连续性肾替代治疗中的应用

Application of regional sodium citrate anticoagulation in continuous renal replacement therapy after cardiac surgery

目的探讨枸橼酸钠体外抗凝在心脏术后连续性肾替代治疗(CRRT)中应用的有效性及安全性。方法选取2017年1月至2018年3月高州市人民医院重症医学科一区收治的心脏术后需CRRT的成人患者76例,将其随机分为三组,A组(26例)为枸橼酸钠(血滤管路输入)抗凝组,B组(28例)为普通肝素(静脉给药)抗凝组,C组(22例)为低分子肝素(静脉给药)抗凝组。比较三组患者滤器使用时间、治疗有效性及不良反应发生情况。结果A组滤器使用时间[(32.4±8.3)h]明显长于B组[(18.2±7.1)h]及C组[(16.4±8.6)h,P均<0.01]。三组患者经治疗后血肌酐均下降(P均<0.01),组间比较无统计学差异(P>0.05);B组发生出血事件8例,C组发生出血事件2例,A组无出血事件亦无电解质紊乱发生。结论在心脏术后CRRT治疗中,与肝素及低分子肝素抗凝相比,应用枸橼酸钠体外抗凝,能延长滤器使用时间,一定程度减少出血事件,同时也能保证血液净化效果。

Objective To explore the efficacy and safety of sodium citrate regional（ extracorporeal） anticoagulation in continuous renal replacement therapy（ CRRT） after cardiac surgery. Methods Seventy-six adult patients requiring CRRT who admitted in Severe Area 1 of Gaozhou People＇s Hospital from January 2017 to March 2018 were selected. The patients were randomly divided into three groups： group A（ anticoagulant of sodium citrate via blood filter pipeline input,n = 26）,group B（ anticoagulant of ordinary heparin via intravenous administration,n = 28） and group C（ anticoagulant of low molecular weight heparin via intravenous administration,n = 22）. Filter using time,treatment effectiveness and adverse reaction were compared among three groups. Results Filter using time in group A was significantly longer than those in group B [（ 32. 4 ± 8. 3） h vs（ 18. 2 ± 7. 1） h,P〈0. 01] and group C [（ 32. 4 ± 8. 3） h vs（ 16. 4 ± 8. 6） h,P〈0. 01].Serum creatinine level after treatment decreased in three groups,but there was no significant difference between three groups（ P〈0. 05）. Hemorrhagic events occurred in 8 cases of group B and in 2 cases of group C. There were no hemorrhagic events and no electrolyte disturbance in group A. Conclusion Compared with ordinary heparin and low molecular weight heparin anticoagulation,application of sodium citrate anticoagulation in vitro can prolong the using time of the filter,reduce bleeding events to a certain extent and ensure the effect of blood purification also in the treatment of CRRT after cardiac surgery.