枸橼酸钠抗凝治疗对重症血液净化患者血液生化指标及凝血功能的影响

Effect of sodium citrate anticoagulant therapy on blood biochemical indexes and coagulation function for patients with severe blood purification

目的 观察枸橼酸钠抗凝治疗对重症血液净化患者血液生化指标及凝血功能的影响。方法 选取2020年1月—2021年12月邵阳市中心医院收治的重症血液净化患者86例,采用奇偶数分组法分为对照组与研究组,各43例。患者均行血液净化治疗,对照组予以低分子肝素钙注射液,研究组予以枸橼酸钠抗凝剂。2组均治疗2周。比较2组临床疗效,治疗前及治疗2周后血液生化指标[血肌酐(SCr)、碳酸氢根(HCO_(3)^(-))、实际离子钙(iCa^(2+))、血清钙离子(Ca^(2+))]、凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT)]、炎性因子[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)],不良反应,治疗成本(滤器使用寿命、每日治疗费用)。结果 研究组总有效率(97.67%)高于对照组(81.40%)(χ^(2)=4.468,P=0.035)。治疗2周后,2组SCr水平低于治疗前,HCO_(3)^(-)、iCa^(2+)高于治疗前,且研究组SCr水平低于对照组,HCO_(3)^(-)高于对照组(P<0.01)。治疗2周后,2组APTT及对照组TT、PT长于治疗前,但研究组APTT、TT、PT短于对照组(P<0.01)。治疗前及治疗2周后,2组CRP、TNF-α、IL-6水平比较,差异无统计学意义(P>0.05);治疗2周后,2组CRP、TNF-α、IL-6水平低于治疗前(P<0.01)。研究组不良反应总发生率为4.65%,低于对照组的18.60%(χ^(2)=4.074,P=0.044)。研究组滤器使用寿命长于对照组,每日治疗费用高于对照组(P<0.01)。结论 重症血液净化患者应用枸橼酸钠抗凝治疗,可进一步改善患者肾功能及机体酸碱代谢平衡,降低机体炎性因子水平,且不会明显影响患者凝血功能,安全性较高。

Objective To study the effect of sodium citrate anticoagulant therapy on blood biochemical indexes and coagulation function for patients with severe blood purification.Methods A total of 86 cases of patients with severe blood purification were selected from January 2020 to December 2021 in Shaoyang Central Hospital,which were randomly divided into control group and study group by odd and even number grouping method,43 cases in each group.All patients were treated with blood purification,the control group was given low molecular weight heparin calcium injection,and the study group was given sodium citrate anticoagulant.Both groups were treated for 2 weeks.Clinical efficacy,blood biochemical indexes(SCr,HCO_(3)^(-),iCa^(2+),serum Ca^(2+)),coagulation indexes(APTT,TT,PT),inflammatory factors(CRP,TNF-α,IL-6)before and after 2 weeks of treatment,adverse reactions,treatment cost(filter service life,daily treatment cost)were compared between the two groups.Results The total effective rate of the study group(97.67%)was higher than that of the control group(81.40%)(χ^(2)=4.468,P=0.035).After 2 weeks of treatment,the SCr of the two groups was lower than that before treatment,while HCO_(3)^(-)and iCa^(2+)were higher than those before treatment,and the SCr of the study group was lower than that of the control group,while HCO_(3)^(-)was higher than that of the control group(P<0.01).After 2 weeks of treatment,APTT of the two groups and TT,PT of the control group were longer than those before treatment,but APTT,TT and PT of the study group were shorter than those of the control group(P<0.01).Before and after 2 weeks of treatment,there was no significant difference of CRP,TNF-αand IL-6 levels between the two groups(P>0.05).After 2 weeks of treatment,the levels of CRP,TNF-αand IL-6 in the two groups were lower than those before treatment(P<0.01).The total incidence of adverse reactions in the study group was 4.65%,lower than 18.60%of the control group(χ^(2)=4.074,P=0.044).The filter service life in the study group was longer than that in the control group,and the daily treatment cost was higher than that in the control group(P<0.01).Conclusion The use of sodium citrate anticoagulant therapy for patients with severe blood purification can further improve the renal function and the balance of body fluid acid-base metabolism,which can reduce the level of inflammatory factors in the body,and will not significantly affect the coagulation function of patients,with high safety.