枸橼酸钠抗凝在高危出血患者血液净化中的应用

Application of Sodium Citrate Anticoagulation in Blood Purification of High Risk Bleeding Patients

目的探讨枸橼酸钠抗凝在高危出血患者血液净化中的临床应用效果。方法以18例尿毒症并发脑出血或消化道出血的患者进行连续性血液净化治疗作为研究对象,所有患者均需进行血液净化治疗,治疗过程中给予枸橼酸钠抗凝。观察滤器前、治疗2 h、4 h、8 h和治疗后0.5 h时全血活化凝血时间(ACT)值;治疗前后血尿素氮(BUN)和血肌酐水平(Cr);滤器凝血情况;治疗前后活化部分凝血活酶时间(APTT)、凝血酶时间(TT)和凝血酶原时间(PT)。结果滤器后不同时间点ACT水平均高于滤器前(P<0.05)。治疗后血BUN和Cr水平低于治疗前(P<0.05),患者抗凝优良率94.44%,抗凝效果较好。治疗前后APTT、TT和PT的比较差异无统计学意义(P>0.05)。结论枸橼酸钠抗凝应用于高危出血患者床边血液净化对全身凝血影响较小,且血液净化效果和抗凝效果较好。

Objective To explore the clinical effect of anticoagulation with sodium citrate in blood purification of high risk bleeding patients.Methods 18 uremic patients with cerebral hemorrhage or gastrointestinal hemorrhage were treated with continuous blood purification.All patients were treated with blood purification and sodium citrate anticoagulation was given during the treatment.The activated clotting time(ACT)of whole blood,bun and Cr levels,clotting condition of filter,APTT,TT and PT 2 h,4 h,8 h before and 0.5 h after treatment were observed.Results At different time points after the filter,the act level was higher than that before the filter(P<0.05).The blood bun and Cr levels after treatment were lower than those before treatment(P<0.05).The excellent and good rate of anticoagulation was 94.44%,and the anticoagulant effect was better.There was no significant difference in APTT,TT and Pt before and after treatment(P>0.05).Conclusion Sodium citrate anticoagulation has little effect on systemic coagulation in blood purification of high risk bleeding patients,and the effect of blood purification and anticoagulation is better.