分析局部枸橼酸钠抗凝技术在重症监护病房(ICU)肝功能障碍患者连续静脉-静脉血液滤过(CVVH)中的安全性、有效性

To Evaluate the Safety and Efficacy of Local Sodium Citrate Anticoagulation on Continuous Veno-venous Hemofiltration(CVVH) for Patients with Liver Dysfunction in ICU

目的总结分析局部枸橼酸钠抗凝技术在重症监护病房(ICU)肝功能障碍患者连续静脉-静脉血液滤过(CVVH)治疗中的应用情况。方法笔者整理了我院在2015年7月至2017年8月期间接诊处理的50例ICU肝功能障碍并实施CVVH治疗患者,患者治疗期间使用局部枸橼酸钠抗凝技术,回顾分析患者治疗前后凝血功能指标、肝功能指标变化、水电解质以及酸碱平衡指标以及治疗期间的并发症发生情况。结果①患者治疗后与治疗前丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)、谷氨酰转移酶(GGT)等肝功能指标差异性较小(P>0.05),不存在统计学意义;②患者治疗后较治疗前乳酸水平、钾离子明显下降,差异明显(P<0.05),存在统计学意义;③所有患者均顺利完成治疗,治疗期间无严重并发症发生;④患者治疗前后的活化部分凝血活酶时间(APTT)差异性较小(P>0.05),无统计学意义。结论ICU肝功能障碍患者采用CVVH治疗期间,应用局部枸橼酸钠抗凝技术对患者肝功能影响较小,并发症少,安全性高。

Objective To summarize and analyze the application of local Sodium Citrate anticoagulation in the treatment of continuous veno-venous hemofiltration(CVVH)for patients with hepatic dysfunction in ICU.Methods A total of 50 patients with liver dysfunction in ICU were treated with CVVH from July 2015 to August 2017.The patients were treated with local Sodium Citrate,the changes of coagulation function index,liver function index,water-electrolyte and acid-base Balance Index before and after treatment and the complications during treatment were analyzed retrospectively.Results(1)Tthere was no significant difference in ALT,aspartate transaminase,Alkaline phosphatase,GGT and other liver function indexes between the patients after treatment and before treatment(P>0.05).(2)The level of lactic acid and potassium decreased significantly after treatment compared with that before treatment(P<0.05),which had statistical significance.(3)All patients completed treatment successfully and no serious complications occurred during treatment.(4)There was no significant difference in activated partial thromboplastin time(APTT)between pre-and post-treatment(P>0.05).Conclusion Patients with liver dysfunction in ICU were treated with CVVH,local Sodium Citrate anticoagulation has less effect on liver function,fewer complications and higher safety.