枸橼酸抗凝血液净化在脓毒性休克患者中的安全性探讨

Safety of Anticoagulant Blood Purification With Sodium Citrate in Septic Shock Patients

目的探讨枸橼酸钠在脓毒性休克患者血液净化中的安全性。方法选择我院ICU 2016年1月—2019年9月收治的80例脓毒性休克合并急性肾损伤与高出血风险需行血液净化治疗的患者为研究对象,随机分为枸橼酸钠组(A组)(42例)与低分子肝素组(B组)(38例),比较两组治疗前、后滤器凝血情况,治疗前后血乳酸、电解质、代谢性酸中毒及血肌酐变化,以及两组管路平均使用寿命;观察血流动力学稳定情况、枸橼酸的不良反应。结果A组滤器和静脉壶凝血明显较少(P<0.05);两组治疗后pH、Na^+、Cr均较治疗前有显著改善(P<0.05);枸橼酸钠组滤器使用时间明显长于低分子肝素组,A组使用达标率高于B组(P<0.05)。结论脓毒性休克患者应用枸橼酸钠抗凝血液净化安全有效。

Objective To explore the safety of sodium citrate in blood purification of septic shock patients.Methods Selecting ICU of our hospital From January 2016 to September 2019,80 patients with septic shock complicated with acute renal injury and high risk of bleeding who need blood purification treatment were randomly divided into sodium citrate group(group A)(42 cases)and low molecular weight heparin group(group B)(38 cases).The coagulation of filter before and after treatment,blood lactate,electrolyte,metabolic acidosis and blood muscle were compared before and after treatment The changes of serum creatinine and the average service life of the two groups were observed.Results The coagulation of filter and venous pelvis in group A was significantly less than that in group B(P<0.05);pH,Na^+,and Cr of the two groups after treatment were significantly improved compared with before treatment(P<0.05);The use time of filter in group A was significantly longer than that in the group B,the use compliance rate of group A was higher than that of group B(P<0.05).Conclusion It is safe and effective to use sodium citrate anticoagulation for blood purification in septic shock patients.