改良式枸橼酸钠与低分子量肝素在急性肾损伤CRRT中的抗凝效果比较

Comparison of anticoagulant effects of modified sodium citrate and low molecular weight heparin in CRRT of acute kidney injury

目的比较两种抗凝方式在急性肾损伤(AKI)患者连续性肾脏替代治疗(CRRT)中的应用效果。方法选取新乡市第一人民医院肾病风湿免疫科2017年7月至2019年7月收治的96例行CRRT的AKI患者作为研究对象,将其随机分为参照组(n=48)和观察组(n=48)。参照组给予低分子量肝素进行抗凝,观察组给予3%枸橼酸钠进行局部抗凝。比较两组患者的前3 d有效治疗剂量、血滤器抗凝效果、活化部分凝血活酶时间(APTT)、血小板(PLT)、血肌酐(SCr)、总胆红素(TB)水平、出血不良事件发生情况。结果观察组的前3 d有效治疗剂量高于参照组(P<0.05)。观察组的血滤器凝血情况优于参照组,血滤器使用时间长于参照组(P<0.05)。治疗后,两组的APTT均延长,但观察组短于参照组(P<0.05);治疗后,两组的PLT、SCr、TB水平均降低(P<0.05),但组间比较,差异无统计学意义(P>0.05)。两组的出血不良事件总发生率比较,差异无统计学意义(P>0.05)。结论改良式枸橼酸钠应用于AKI患者CRRT中的局部抗凝效果较佳,可提高前3 d有效治疗剂量,延长血滤器使用时间,减少患者治疗期间出血风险,且对PLT、SCr、TB水平影响较小。

Objective To compare the application effects of two anticoagulant methods in continuous renal replacement therapy(CRRT)in patients with acute kidney injury.Methods A total of 96 AKI patients treated with CRRT admitted in nephrology,rheumatism and immunology department of Xinxiang first people's hospital from July 2017 to July 2019 were selected as the research objects,and the patients were randomly divided into reference group(n=48)and observation group(n=48).The reference group was given low molecular weight heparin for anticoagulation,and the observation group was given 3%sodium citrate for local anticoagulation.The effective treatment dose in the first 3 d,anticoagulant effect of blood filter,activated partial thromloplastin time(APTT),platelet(PLT),serum creatinine(SCr),total bilirubin(TB)levels and the occurrence of bleeding adverse events were compared between the two groups.Results The effective treatment dose in the first 3 d of the observation group was higher than that of the reference group(P<0.05).The coagulation of blood filter of the observation group was better than that of the reference group,and the use time of blood filter was longer than that of the reference group(P<0.05).After treatment,the APTT in the two groups prolonged,but that in the observation group was shorter than the reference group(P<0.05);after treatment,the PLT,SCr and TB levels in the two groups decreased(P<0.05),but there were no significant differences between the two groups(P>0.05).There was no significant difference in the total incidence of bleeding adverse events between the two groups(P>0.05).Conclusion Modified sodium citrate applied in CRRT of AKI patients has better local anticoagulant effect,it can increase the effective treatment dose in the first 3 d,prolong the use time of blood filter,reduce the risk of bleedingduring treatment,and has little effect on PLT,SCr and TB levels.