枸橼酸在高危出血患者连续性血液净化中的应用效果

Application Effects of Citric acid in the Continuous Blood Purification for old Patients with High-Risk Bleeding

目的探讨枸橼酸在高危出血患者连续性血液净化(CBP)中的应用效果。方法选取2017年1月至2018年10月本院ICU收治的100例需要进行CBP治疗的高危出血倾向患者,并用随机数字法将其随机分为A组(枸橼酸抗凝)、B组(低相对分子质量肝素抗凝)各50例;记录和比较2组患者治疗前、后的呼吸、心率、收缩压及血氧饱和度(SpO2);治疗前和治疗24 h、治疗72 h结束后的全血活化凝血时间(WBACT),凝血酶时间(TT),纤维蛋白原(Fbg),碱剩余(BE)、氢离子浓度指数(pH值),钙离子(Ca^2+)浓度变化等。结果A组经过治疗结束后收缩压和SpO2高于B组(P<0.05);A组治疗24 h后滤器后WBACT、Fbg、pH值、Ca^2+浓度低于B组(P<0.05),治疗72 h后滤器前WBACT和BE低于B组(P<0.05),Ca^2+浓度低于B组(P<0.05),组间其他比较差异无统计学意义(P>0.05)。结论高危出血患者CBP中使用枸橼酸治疗有利于血压、SpO2、Ca^2+浓度的改善,降低WBACT。

Objective To explore the application effects of citric acid in the continuous blood purification(CBP)of patients with high-risk bleeding.Methods 100 patients with high-risk bleeding tendency who required CBP treatment in the hospital from January 2017 to October 2018 were selected and randomly assigned to group A(citric acid anticoagulant therapy)and group B(low molecular weight heparin anticoagulant therapy)according to the random number table method,with 50 cases in each group.The respiratory and heart rate,systolic blood pressure and oxygen saturation(SpO2)before and after treatment,and whole blood activated clotting time(WBACT),thrombin time(TT),fibrinogen(Fbg),base excess(BE),hydrogen ion concentration index(pH value)and calcium ion(Ca^2+)concentration before treatment and after 24 h and 72 h of treatment were recorded and compared between the two groups.Results After the end of treatment,the systolic blood pressure and SpO2 in group A were higher than those in group B(P<0.05).The WBACT,Fib,pH value and Ca^2+concentration in group A after filter after 24 h of treatment were lower than those in group B(P<0.05),and the WBACT and BE before filter after 72 h of treatment were lower than those in group B(P<0.05),and the Ca^2+concentration was lower than that in group B(P<0.05),and there were no significant differences in the others between the two groups(P>0.05).Conclusion Citric acid in CBP of patients with high-risk bleeding is beneficial to the improvement of blood pressure,SpO2 and Ca^2+concentration and the reduction of WBACT.