枸橼酸钠抗凝在儿童血液净化中的有效性与安全性研究

Study on the efficacy and safety of sodium citrate anticoagulation in continuous blood purification for children

目的:探讨局部枸橼酸钠抗凝(RCA)技术在儿童血液净化中的有效性和安全性。方法:将43例行连续性血液净化(CBP)治疗的患儿分为肝素抗凝组(20例)和枸橼酸钠抗凝组(23例)。观察两组治疗时间、滤器使用时间,滤器、静脉壶的凝血情况,治疗前及治疗过程中APTT及电解质、血气分析等指标。结果:(1)枸橼酸钠抗凝组平均治疗时间及滤器使用时间均要显著高于肝素抗凝组(P<0.05);(2)枸橼酸钠抗凝组滤器和静脉壶的凝血发生率和严重程度均明显低于肝素抗凝组(P<0.05);(3)枸橼酸抗凝组原有出血加重和新发出血发生率均明显低于肝素抗凝组,枸橼酸纳抗凝组在CBP治疗过程中未见新发出血(P<0.05);(4)肝素抗凝组治疗后APTT明显延长(P<0.05),枸橼酸钠抗凝组治疗前后APTT无明显变化(P>0.05);治疗后,肝素抗凝组较枸橼酸钠抗凝组APTT明显延长(P<0.05);(5)肝素抗凝组治疗前后内环境无明显变化(P>0.05),电解质、酸碱维持在正常范围;枸橼酸钠抗凝组治疗前后Na+、iCa2+I、总钙浓度维持在正常水平(P>0.05),治疗后pH、HCO-3呈逐步上升趋势,治疗12h后出现代谢性碱中毒(P<0.05);两组同一治疗时间点的Na+、iCa2+I、总钙浓度比较差异无统计学意义(P>0.05);治疗8h后,枸橼酸钠抗凝组pH、HCO-3较肝素抗凝组高,枸橼酸钠抗凝组最终有代谢性碱中毒(P<0.05)。结论:RCA在儿童血液净化治疗过程中可获得良好的局部抗凝效果,可以安全有效地用于儿童CBP治疗。

Objective：To discuss effectiveness and safety of sodium citrate anticoagulation in continuous blood purification（CBP）for children.Method：A total of 43 children undergoing CBP treatment were divided into heparin anticoagulation group（20 cases）and sodium citrate anticoagulation group（23 cases）.Treatment time,using time of filters,anticoagulation condition in filters and intravenous pots,APTT,electrolyte and blood gas analysis in both groups before treatment and during treatment process were observed.Result：（1）The average treatment time and filter using time in sodium citrate anticoagulation group were significantly higher than that in heparin anticoagulation group（P〈0.05）.（2）The anticoagulation occurrence rate in filters and intravenous pots and the severity degree in sodium citrate anticoagulation group were both evidently lower than that in heparin anticoagulation group（P〈0.05）.（3）The original bleeding in sodium citrate anticoagulation group was worsening and the occurrence rate of new bleeding was evidently lower than that in heparin anticoagulation group.During CBP process,no new bleeding occurred to child patients in sodium citrate anticoagulation group（P〈0.05）.（4）APTT in heparin anticoagulation group after treatment was evidently prolonged（P〈0.05）.APTT in sodium citrate anticoagulation group before and after treatment had no evident changes（P〈0.05）.Comparing child patients in both groups after treatment,APTT in heparin anticoagulation group was evidently longer than that in sodium citrate anticoagulation group（P〈0.05）.（5）In heparin anticoagulation group,internal environment before and after treatment had no evident changes（P〈0.05）,electrolyte and power of hydrogen were maintained in the normal range.In sodium citrate anticoagulation group,Na＋,iCa2＋I,total calcium concentration before and after treatment were maintained in normal range（P〈0.05）and pH,HCO-3 after treatment increased gradually.At 12 hafter treatment,metabolic alkalosis occurred（P〈0.05）.Na＋,iCa2＋Iand total calcium concentration at the same treatment point between two groups were not statistically significant（P〈0.05）.pH,HCO-3 of child patients in sodium citrate anticoagulation group at the same treatment time after 2 hwere higher than that in heparin anticoagulation group.Metabolic alkalosis occurred in sodium citrate anticoagulation group finally（P〈0.05）.Conclusion：Local sodium citrate anticoagulation has a good local anticoagulation effect during the treatment process of blood purification among children,so it can be used in children CBP treatment safely and effectively.