枸橼酸抗凝在心脏术后早期急性肾损伤患者血液净化治疗中的应用

Application of citrate anticoagulation in blood purification therapy for patients with early acute kidney injury after cardiac surgery

目的研究局部枸橼酸抗凝技术(RCA)在心脏术后早期急性肾损伤(AKI)连续性血液净化治疗(CRRT)中的抗凝效果以及安全性。方法 47例心脏术后早期出现急性肾损伤的患者接受CRRT治疗,所有患者随机分为两组,治疗组24例采用枸橼酸局部抗凝技术,对照组23例采用无抗凝技术,监测两组滤器及管路的使用寿命,比较治疗后血小板计数、部分凝血活酶时间(APTT)、pH值、HCO3-、离子钙(iCa2+)及血乳酸(Lac)水平等指标,比较两组预后。结果治疗组滤器及管路的使用寿命明显高于对照组(P<0.05);治疗48 h后,两组患者的血小板水平较之前均有下降,但治疗组下降程度较小(P<0.05)。治疗48 h后两组的APTT、pH、iCa2+、Lac等指标差异无统计学意义;两组患者的病死率差异无统计学意义。结论局部枸橼酸抗凝技术对于心脏术后早期AKI的CRRT抗凝效果良好,有效的延长了滤器及管路的使用寿命,减少了血小板的损耗,保证CRRT的顺利进行。

Objective To study the anticoagulant effect and safety of regional citric acid anticoagulation （RCA） for continuous blood purification inthe early stage of acute kidney injury （AKI） after cardiac surgery. Methods 47 cases of postoperative early acute kidney injury in patients receiving CRRT treatment, all patients were randomly divided into two groups, the treatment group of 24 cases by local citrate aaaticoagulation, 23 cases in the control group with no anticoagulation, monitoring two groups of filter and pipeline service life, platelet count, partial thromboplastin time comparison treatment after treatment （APTT）, pH, HCO3, calcium ion （iCa2＋） and blood lactate （Lac） levels and other indicators, the prognosis was compared between two groups. Results The life span of filters and pipelines in the treatment group was significantly higher than that in the control group （P〈0.05）. After 48 hours of treatment, the platelet level of the two groups decreased, but the treatment group decreased slightly （P〈0.05）. After 48 hours of treatment, there was no significant difference in the indexes of APTT, pH, iCa2＋ and Lac in the two groups, and there was no significant difference in the mortality between the two groups. Conclusion Local citric acid anticoagulation technology is effective for CRRT anticoagnlation in early stage of AKI after cardiac surgery, effectively prolonging the service life of filters and pipelines, reducing platelet loss and ensuring thesmooth progress of CRRT.