局部枸橼酸抗凝在无肝素血液透析治疗中的应用及护理分析

Application and Nursing of Local Citric Acid Anticoagulation in Hemodialysis without Heparin

目的探讨分析局部枸橼酸抗凝在无肝素血液透析治疗中的应用及护理经验。方法将2018年1月—2019年12月间在该院接受治疗的66例无肝素血液透析治疗患者分为两组,对照组与观察组各33例,两组均采取无肝素血液透析治疗及相应的护理服务,观察组在对照组常规护理基础上开展针对性护理干预。比较两组患者的出血倾向视觉模拟评分(VAS)、ACT与凝血时间以及治疗情况。结果护理后,观察组患者的VAS评分(5.04±0.15)分,显著低于对照组的(6.13±0.17)分;且与对照组相比,护理后观察组患者的ACT与凝血时间改善更为显著,两组数据差异有统计学意义(t=4.011、-4.137、-5.096,P=0.026、0.027、0.017)。两组透析治疗均顺利完成,透析过程中两组患者均无新出血、枸橼酸酸中毒、低钙以及代谢性碱中毒等相关不良反应。结论在无肝素血液透析治疗中,局部应用枸橼酸抗凝,其临床效果满意,同时不会引起体内抗凝效应,对出血并发症有良好的预防作用;另外,在护理过程中应密切关注钙离子目标值,监测抗凝相关并发症,最大限度地降低血透风险。

Objective To explore the application and nursing experience of local citrate anticoagulation in heparin-free hemodialysis treatment.Methods 66 patients without heparin hemodialysis who were treated in the hospital from January 2018 to December 2019 were divided into two groups;the control group and the observation group each had 33 cases,and both groups were treated with heparin-free hemodialysis and the corresponding nursing management,the observation group carried out targeted nursing on this basis.The visual simulation score(VAS),ACT and coagulation time and treatment status of bleeding tendency of the two groups were compared.Results After nursing,the VAS score of the observation group was(5.04±0.15)points,which was significantly lower than that of the control group(6.13±0.17)points;compared with the control group,the ACT and clotting time of patients in the observation group after nursing improved more significantly,and the difference in data between the two groups was statistically significant(t=4.011,-4.137,-5.096,P=0.026,0.027,0.017).The dialysis treatment of both groups was completed successfully.During the dialysis process,there were no related adverse reactions such as new bleeding,citric acidosis,low calcium and metabolic alkalosis.Conclusion In heparin-free hemodialysis treatment,topical application of citric acid anticoagulation has a satisfactory clinical effect,and it will not cause anticoagulation effect in vivo,and has a good preventive effect on bleeding complications;in addition,during the nursing process,we should pay close attention to the calcium ion target value,monitor anticoagulation-related complications,and minimize the risk of hemodialysis.