不同浓度枸橼酸钠用于日间连续性肾脏替代治疗的抗凝效果比较

The comparative analysis of different concentrations sodium citrate used in anticoagulation for daytime continuous renal replacement therapy

目的分析并比较不同浓度枸橼酸钠抗凝剂应用于日间连续性肾脏替代治疗(DCRRT)的效果。方法回顾性选取2015年1月至2021年1月在长征医院南京分院及南京江北人民医院收治的43例因活动性出血或伴有出血倾向以不同浓度枸橼酸钠体外抗凝性DCRRT治疗的ESRD患者,将其随机分为A组(21例,以4%浓度枸橼酸钠体外抗凝)及B组(22例,以30%浓度枸橼酸钠体外抗凝)。两组均选用不含碱基置换液行日间连续性肾脏替代治疗,A组外周静脉补充碱基,B组不额外补充碱基。监测并计算两组的外周血生化指标[血肌酐(Scr)、谷丙转氨酶(ALT)、血清总胆红素(TB)、pH值、Na+、外周Ca2+、滤器后Ca2+、HCO3-]、动脉血气[碱剩余(BE)]、凝血指标[活化部分促凝血酶原激酶时间(APTT)]变化,同时监测并计算A、B两组治疗同时间段的入液量及超滤量。结果两组均完成12 h的DCRRT治疗模式,患者治疗期间无口唇麻木、低钙抽搐等临床不适症状。两组治疗前及治疗4、8、12 h时的各项血生化指标、动脉血气、凝血指标比较,组间差异均无统计学意义(均P>0.05)。两组治疗12 h时的Na+浓度均高于治疗前,差异有统计学意义(P<0.05);两组治疗4、8、12 h的滤器后Ca2+均低于治疗前,差异均有统计学意义(均P<0.05);两组治疗12 h后的pH值、BE及HCO3-均高于治疗前,差异均有统计学意义(均P<0.05);两组治疗8、12 h后的血Scr均低于治疗前,差异均有统计学意义(均P<0.05);两组治疗前与治疗后的其他指标(包括外周Ca2+、APTT、ALT、TB)比较,差异均无统计学意义(均P>0.05)。治疗同时间段的入液量及超滤量比较,B组显著低于A组,差异均有统计学意义(均P<0.01)。结论两种不同浓度枸橼酸钠应用于DCRRT均是安全有效的抗凝方式,高浓度枸橼酸钠抗凝操作较低浓度简便实用,易于临床推广。

Objective To observe and compare the effects of different concentrations of sodium citrate anticoagulant in daytime continuous renal replacement therapy(DCRRT).MethodssFrom January 2015 to January 2021,43 ESRD patients with active bleeding or bleeding tendency treated with anticoagulant DCRRT with different concentrations of sodium citrate in Nanjing branch of changzheng hospital and Nanjing Jiangbei people's hospital were selected retrospectively.They were randomly divided into two groups:group A(21 cases,4%sodium citrate)and group B(22 cases,30%sodium citrate).Base free substitution fluids was used for the two groups treated with daytime continuous renal replacement therapy.The peripheral vein of group A was supplemented with base,while the peripheral vein of group B was not supplemented with additional base.The peripheral blood biochemical indexes,arterial blood gas,coagulation index and post-filter indexes were monitored and calculated.At the same time,the fluid infusion volume and ultrafiltration volume of group A and group B were monitored and calculated.Results Both groups completed the DCRRT treatment mode for 12 hours,and there were no clinical symptoms such as lip numbness,hypocalcium convulsions during the treatment.There were no significant differences in blood biochemistry indexes,arterial blood gas and coagulation indexes between the two groups before treatment and at 4,8 and 12 h after treatment(all P>0.05).The Na*concentration of the two groups at 12 h after treatment was higher than that before treatment,and the difference was statistically significant(P<0.05).The Ca?+after 4,8 and 12 h of treatment in the two groups was lower than that before treatment,and the differences were statistically significant(all P<0.01).The pH value,BE and HCO,of the two groups after 12 h of treatment were higher than those before treatment,and the differences were statistically significant(allP<0.05).The blood Scr of the two groups after 8 and 12 h of treatment were lower than those before treatment,and the differences were statistically significant(allP<0.05).There was no significant difference in other indexes between the two groups before and after treatment(all P>0.05).During the same period of treatment,the fluid intake and ultrafiltration volume in group B were significantly lower than those in group A,and the differences were statistically significant(allP<0.01).Conclusions The two dfferent concentrations of sodium citrate are safe and effective anticoagulant methods for DCRRT.The anticoagulant operation of high concentration sodium citrate is simpler and more practical than that of low concentration group,which is easy to be popularized in clinical practice.