局部枸橼酸抗凝在高危出血风险患者血液净化治疗中的应用

Application of regional citrate anticoagulation in blood purification treatment of patients with high risk of bleeding

目的探讨局部枸橼酸抗凝在高危出血风险患者血液净化治疗中的应用效果。方法选择2015年5月至2017年10月我科存在高危出血风险且行血液净化治疗的患者50例,将其随机分为观察组24例和对照组26例,观察组采用局部枸橼酸抗凝,对照组采用肝素抗凝。比较两组患者上机前后血清、凝血指标变化情况,更换滤器时、上机后出血发生情况。结果上机8 h后,两组患者血清指标均明显改善,观察组改善效果优于对照组,差异有统计学意义(P <0. 05);上机2 h后,两组患者活化部分凝血活酶时间、活化凝血时间均有所延长,观察组上机前后比较,差异无统计学意义(P> 0. 05),对照组上机前后比较差异有统计学意义(P <0. 05);观察组更换滤器时凝血发生率及上机后出血发生率均明显低于对照组(P <0. 05)。结论局部枸橼酸抗凝在高危出血风险患者血液净化治疗中应用效果良好,值得推广。

Objective To explore the application effect of regional citrate anticoagulation in blood purification treatment of patients with high risk of bleeding. Methods To select 50 cases of patients with high risk of bleeding who underwent blood purification treatment in our department from May 2015 to October 2017 as the study subjects. They were divided into observation group with 24 cases and control group with 26 cases randomly. The observation group was treated with regional citrate anticoagulation, while the control group was treated with heparin anticoagulation. The changes of serum and coagulation parameters before and after the patients were connected to the machine were compared between the two groups. Meanwhile, the occurrence of bleeding after the filter was replaced and after the patients were connected to the machine were compared. Results After 8 hours connecting to the machine, the serum indexes of the two groups were significantly improved. The improvement effect of the observation group was better than that of the control group,and the difference was statistically significant( P <0.05). After 2 hours connecting to the machine, the activation time of partial thromboplastin and activated clotting time were prolonged. There was no significant statistical difference between the time in the observation group before and after the patients were connected to the machine( P >0.05), while the difference between the before and after the connected to the machine of control group was statistically significant( P <0.05). The incidence of coagulation at the time of replacing filter and the incidence of bleeding after the patients were connected to the machine in the observation group were significantly lower than that in the control group( P <0.05). Conclusion Regional citrate anticoagulation is effective in the treatment of blood purification in patients with high risk of bleeding,which was worth popularizing.