两种碳酸氢盐透析液对血液透析患者低分子肝素用量及急性并发症的影响

Effects of two different bicarbonate dialysates on low molecular weight heparin dosage and acute complications in hemodialysis patients

目的探讨枸橼酸碳酸氢盐透析液与醋酸碳酸氢盐透析液对血液透析患者低分子肝素用量及急性并发症的影响。方法选取2018年10至12月在桐乡市第一人民医院血液净化中心进行维持性血液透析的78例患者为研究对象。采用自身前后对照,所有患者先予以醋酸碳酸氢盐透析液进行血液透析4周,设为醋酸组;然后予以枸橼酸碳酸氢盐透析液进行血液透析4周,设为枸橼酸组。采用视觉凝血分数法评估透析器及管路凝血情况,以调整低分子肝素剂量至最低值;完成4周血液透析后检测电解质水平,记录血液透析急性并发症。结果两种透析液分别进行血液透析936次。血液透析过程中,枸橼酸组血液透析所需低分子肝素最低剂量明显低于醋酸组(P<0.05)。4周血液透析结束后,枸橼酸组校正血钙、镁水平较醋酸组明显下降(均P<0.05),但低钙血症发生率比较差异无统计学意义(P>0.05),均未发生严重的低钙血症和低镁血症。枸橼酸组血磷水平较醋酸组明显升高(P<0.05),且高磷血症发生率亦明显升高(P<0.05)。枸橼酸组透析过程中发生肌肉痉挛、透析中低血压的比例明显高于醋酸组,透析中高血压的比例明显低于醋酸组,差异均有统计学意义(均P<0.05);其他急性并发症发生率比较,差异无统计学意义(P>0.05)。结论相比于醋酸碳酸氢盐透析液,使用枸橼酸碳酸氢盐透析液患者所需低分子肝素剂量减少,且发生透析中高血压更少,但发生透析中低血压及肌肉痉挛增多,有一定的降血钙、升血磷的风险。建议个体化选择透析液。

Objective To investigate the effects of citrate bicarbonate dialysate and acetate bicarbonate dialysate on low molecular weight heparin(LMWH)dosage and acute complications during hemodialysis.Methods This study was a self-control study selecting 78 patients who underwent maintenance hemodialysis at the Blood Purification Center of Tongxiang First People's Hospital from October to December 2018.The acetate bicarbonate dialysate was used for hemodialysis in the first 4 weeks(acetate group),then citrate bicarbonate dialysate was used for 4 weeks(citrate group).The coagulation condition of dialyzer and pipeline was evaluated by visual clotting score to adjust the dose of LMWH to the lowest value and adverse reactions during dialysis were recorded.The blood electrolyte level were performed after 4 weeks of hemodialysis in each group.Results The hemodialysis was performed for 936 times with each type of dialysate.The lowest dose of LMWH required for hemodialysis in the citrate bicarbonate dialysate group was lower than that in the acetate bicarbonate dialysate group(P<0.05).Compared with the acetate group,the citrate group had a decrease in correcting serum calcium,and serum magnesium(both P<0.05),However,there was no significant difference in the incidence of hypocalcemia(P>0.05),and no severe hypocalcemia and hypomagnesemia occurred.The serum phosphorus level was increased(P<0.05)and the incidence of hyperphosphatemia increased in citrate group(P<0.05).The incidence of muscle twitching and intradialytic hypotension in the citrate group was higher than that in the acetate group,and the incidence of intradialytic hypertension was lower than that of the acetate group(both P<0.05).There was no statistically significant difference in the incidence of other acute complications between two groups(P>0.05).Conclusion Compared with acetate bicarbonate dialysate,the citrate bicarbonate dialysate has a lower dose of low molecular weight heparin required for hemodialysis and better control of intradialytic hypertension,but more incidence of intradialytic hypotension and muscle twitching,and has the risk of reducing serumcalcium and increasing serum phosphorus to some extent,indicating that individualized selection of dialysate is recommended.