不同浓度枸橼酸钠分段式抗凝方案在血液透析患者中的抗凝效果对比

Comparison on anticoagulant effect of different concentrations of sodium citrate staged anticoagulation in hemodialysis patients

目的比较不同浓度枸橼酸钠分段式抗凝方案在血液透析患者中的抗凝效果。方法选取2019年1月~2021年1月在我院接受血液透析治疗的150例患者作为研究对象,采用随机数字表法分为5组,每组30例,其中2.5%和4%枸橼酸钠一段式抗凝组分别在透析器前泵入2.5%、4%枸橼酸钠;2.5%和4%枸橼酸钠分段式抗凝组分别在透析器前及静脉壶处泵入2.5%、4%枸橼酸钠。治疗结束时比较5组抗凝效果,测定治疗前(T_(0))、治疗后第1 h(T_(1))、2 h(T_(2))、3 h(T_(3))、4 h(T_(4))时的凝血功能指标[凝血酶时间(TT)、凝血酶原时间(PT)、纤维蛋白原(FIB)及活化部分凝血活酶时间(APTT)]、电解质指标[碳酸氢根(HCO_(3)^(-))、钙离子(Ca^(2+))、钾离子(K^(+))、pH]、游离钙离子(iCa^(2+))[动脉端(A)、滤器后(V)],并比较5组患者透析充分性(尿素氮清除率、尿素清除量/体积),统计治疗期间,5组不良反应。结果4%枸橼酸钠分段式抗凝组抗凝效果优于无肝素组、2.5%枸橼酸钠一段式抗凝组、4%枸橼酸钠一段式抗凝组,且抗凝总有效率高于无肝素组、2.5%枸橼酸钠一段式抗凝组、4%枸橼酸钠一段式抗凝组,差异有统计学意义(P<0.05);2.5%枸橼酸钠分段式抗凝组与4%枸橼酸钠分段式抗凝组抗凝总有效率比较差异无统计学意义(P>0.05);5组T_(0)、T_(1)、T_(2)、T_(3)、T_(4)时的PT、TT、APTT、FIB比较差异无统计学意义(P>0.05);5组T_(0)时的PT、TT、APTT、FIB与T_(1)、T_(2)、T_(3)、T_(4)时比较差异有统计学意义(P<0.05);5组T_(0)时的K^(+)、HCO_(3)^(-)比较差异无统计学意义(P>0.05);T_(1)、T_(2)、T_(3)、T_(4)时,5组间的K^(+)、HCO_(3)^(-)、Ca^(2+)、pH比较差异有统计学意义(P<0.05),2.5%枸橼酸钠分段式抗凝组低于无肝素组、2.5%枸橼酸钠一段式抗凝组、4%枸橼酸钠一段式抗凝组、4%枸橼酸钠分段式抗凝组(P<0.05);5组T_(0)时的K^(+)、HCO_(3)^(-)与T_(1)、T_(2)、T_(3)、T_(4)时比较差异有统计学意义(P<0.05);5组T_(0)、T_(1)、T_(2)、T_(3)、T_(4)时的Ca^(2+)、pH比较差异无统计学意义(P>0.05);5组T_(1)、T_(2)、T_(3)、T_(4)时的A iCa^(2+)、V iCa^(2+)比较无统计学差异(P>0.05);5组T_(0)时的A iCa^(2+)、V iCa^(2+)与T_(1)、T_(2)、T_(3)、T_(4)时比较差异有统计学意义(P<0.05);5组患者透析充分性(尿素氮清除率、尿素清除量/体积)相比,差异无统计学意义(P>0.05);5组不良反应发生率比较差异无统计学意义(P>0.05)。结论血液透析患者在透析器前及静脉壶处泵入2.5%和4%枸橼酸钠均有较高的抗凝效果,其中透析器前及静脉壶处泵入2.5%枸橼酸钠可有效调节患者的电解质水平,且有一定的安全性。

Objective To compare the anticoagulant effect of different concentrations of sodium citrate staged anticoagulation in hemodialysis patients.Methods 150 patients who received hemodialysis in the hospital from January 2019 to January 2021 were selected as the research subjects,and a random number table method was used to divide them into 5 groups with 30 cases in each group.In the 2.5%sodium citrate one-stage anticoagulation group and 4%sodium citrate one-stage anticoagulation group,2.5%and 4%sodium citrate was pumped at the dialyzer;in the 2.5%sodium citrate staged anticoagulation group and 4%sodium citrate staged anticoagulation group,2.5%and 4%sodium citrate was pumped at the dialyzer and venous kettle.At the end of treatment,the anticoagulant effect among the five groups was compared.The coagulation function indexes[thrombin time(TT),prothrombin time(PT),fibrinogen(FIB),activated partial thromboplastin time(APTT)],electrolyte indexes[bicarbonate(HCO_(3)^(–)),calcium ion(Ca^(2+)),potassium ion(K^(+)),pH]and free calcium ion[arterial end(A),after filter(V)]were measured and compared before treatment(T_(0)),on the 1^(st) h(T_(1)),2^(nd) h(T_(2)),3^(rd) h(T_(3))and 4^(th) h(T_(4))after treatment(iCa^(2+)).The dialysis adequacy(urea nitrogen clearance rate,urea clearance/volume)of patients among the five groups were compared.During treatment,the adverse reactions among the five groups were counted.Results The anticoagulation effect of 4%sodium citrate staged anticoagulation group was better than that of non heparin group,2.5%sodium citrate one-stage anticoagulation group and 4%sodium citrate one-stage anticoagulation group,and the total effective rate of anticoagulation was higher than that of non heparin group,2.5%sodium citrate one-stage anticoagulation group and 4%sodium citrate one-stage anticoagulation group,there were statistical significant differences(P<0.05);there was no statistical significant difference in the total effective rate of anticoagulation between 2.5%sodium citrate segmented anticoagulation group and 4%sodium citrate segmented anticoagulation group(P>0.05);there was no statistical difference in PT,TT,APTT and FIB at T_(0),T_(1),T_(2),T_(3)and T_(4) among the five groups(P>0.05);compared PT,TT,APTT and FIB among the five groups at T_(0)with those at T_(1),T_(2),T_(3)and T_(4),there were statistical significant differences(P<0.05);there was no statistical difference in K^(+)and HCO_(3)^(–)at T_(0) among the five groups(P>0.05);compared K^(+),HCO_(3)^(–),Ca^(2+),pH among the five groups at T_(0 )with those at T_(1),T_(2),T_(3)and T_(4),there were statistical significant differences(P<0.05),2.5%sodium citrate staged anticoagulation group was lower than non heparin group,2.5%sodium citrate one-stage anticoagulation group,4%sodium citrate one-stage anticoagulation group and 4%sodium citrate staged anticoagulation group(P<0.05);compared K^(+),HCO_(3)^(–)among the five groups at T_(0)with those at T_(1),T_(2),T_(3) and T_(4)(P<0.05);there was no significant difference in Ca^(2+) and pH among the five groups at T_(0),T_(1),T_(2),T_(3)and T_(4)(P>0.05);there was no significant difference in A iCa^(2+) and ViCa^(2+)at T_(0),T_(1),T_(2),T_(3)and T_(4) among the five groups(P>0.05);compared A iCa^(2+) and ViCa^(2+)among 5 groups at T_(0)with those at T_(1),T_(2),T_(3)and T_(4),there were statistical significant differences(P<0.05);there was no statistical significant difference in dialysis adequacy(urea nitrogen clearance rate,urea clearance/volume)of patients among the five groups(P>0.05);there was no statistical significant difference in the incidence of adverse reactions among the five groups(P>0.05).Conclusion Pumping 2.5%and 4%sodium citrate in front of dialyzer and venous kettle has high anticoagulant effect in hemodialysis patients,of which pumping 2.5%sodium citrate at the dialyzer and venous kettle can effectively adjust the electrolyte level of patients,and has certain safety.