局部枸橼酸钠抗凝在ICU高危出血患者血液净化中的应用效果

Effect of local sodium citrate anticoagulation on blood purification in patients with high-risk bleeding in ICU

目的 探讨局部枸橼酸钠、阿加曲班及局部肝素抗凝技术在ICU高危出血风险患者血液净化中的安全性和有效性。方法 选择我院2018年1~10月收治120例高危出血风险行血液净化治疗的ICU重症患者随机分为三组,A组(45例)采用枸橼酸钠抗凝法,B组(43例)采用阿加曲班抗凝法,C组(32例)采用局部肝素体外抗凝。观察三组滤器、静脉壶的凝血情况,治疗前、后凝血指标及生化指标。结果 C组滤器和静脉壶凝血情况严重程度及发生率高于A组和B组(P<0.05)。与治疗前相比,各组患者治疗后APTT、PT、TT明显升高,而FBG明显降低(P<0.05),B组较A组和C组治疗后APTT、PT及TT升高更明显,FBG显著降低(P<0.05)。治疗后纠正了三组患者的代谢酸中毒,肾功能的血清Cr较治疗前降低,HCO3-较治疗前升高,A组较B组和C组血Cr水平降低更明显(P<0.05)。结论 局部枸橼酸钠抗凝技术在连续血液净化治疗过程中可取得良好的局部抗凝效果,出血风险低,是高危出血风险患者理想的体外抗凝方法。

Objective To investigate the safety and efficacy of topical sodium citrate, argatroban and local heparin anticoagulation in blood purification of patients with high risk of hemorrhage in ICU. Methods 120 patients with high risk of hemorrhage from Jan to Oct in 2018 were randomly divided into three groups. Group A (45 cases) used sodium citrate anticoagulant method, group B (43 cases) used argatroban anticoagulant method, group C (32 cases) used local heparin anticoagulation in vitro. Observed the coagulation status of the three groups of filters and intravenous jugs, blood coagulation indicators and biochemical indicators before and after treatment. Results The severity and incidence of coagulation and venous pots in group C were higher than those in group A and B (P<0.05). Compared with pre-treatment, APTT, PT and TT significantly increased and FBG significantly decreased in each group (P<0.05). The APTT, PT and TT significantly increased in group B than in group A and C, FBG significantly decreased (P<0.05). After treatment, the bicarbonate level was higher than before treatment. The metabolic acidosis was corrected, and the serum creatinine level was lower than that before treatment. Among the three groups, the serum creatinine level was significantly lower in group A than in group B and C (P<0.05). Conclusion Local sodium citrate anticoagulant technology can achieve good local anticoagulant effect and low bleeding risk in continuous blood purification treatment. It is an ideal anticoagulation method for patients with high risk of bleeding in vitro.