不同抗凝方案在严重脓毒症伴血小板减少患者连续性肾脏替代治疗中的应用效果

Effect of Different Anticoagulant Regimens on Continuous Renal Replacement Therapy in Patients with Severe Sepsis and Thrombocytopenia

目的:分析不同抗凝方案在严重脓毒症伴血小板减少患者连续性肾脏替代治疗(CRRT)中的应用效果。方法:选取2022年5月—2023年5月临沂市中心医院收治的严重脓毒症伴血小板减少患者70例为研究对象,随机分为参照组和试验组,各35例。两组均接受常规CRRT,参照组采用普通肝素抗凝,试验组采用枸橼酸钠局部抗凝。比较两组凝血功能、肌酸激酶同工酶(CK-MB)、总胆红素、滤器使用寿命、肾功能指标、电解质水平。结果:治疗后,试验组凝血酶原时间、活化部分凝血活酶时间低于参照组,血小板计数高于参照组(P<0.05)。治疗后,两组CK-MB、总胆红素水平降低,试验组CK-MB水平低于参照组(P<0.05)。试验组滤器使用寿命长于参照组(P<0.001)。治疗后,两组血尿素氮、肌酐水平降低,HCO3-水平升高,试验组Ca2+、HCO3-水平低于参照组(P<0.05)。结论:枸橼酸钠局部抗凝在严重脓毒症血小板减少患者CRRT中的抗凝效果较好,能够减轻肾功能损伤,降低CK-MB水平,延长滤器使用寿命,维持电解质平衡。

Objective:To analyze the effects of different anticoagulant regimens on continuous renal replacement therapy(CRRT)in patients with severe sepsis and thrombocytopenia.Methods:Seventy patients with severe sepsis with thrombocytopenia admitted to Linyi Central Hospital from May 2022 to May 2023 were selected as the study objects,and randomly divided into the reference group and the experimental group,with thirty-five cases in each group.Both groups received conventional CRRT,the reference group received ordinary heparin for anticoagulation,and the experimental group received sodium citrate for local anticoagulation.Coagulation function,creatine kinase isoenzyme(CK-MB),total bilirubin,filter service life,renal function index and electrolyte level were compared between the two groups.Results:After treatment,the prothrombin time and activated partial thrombin time of experimental group were lower than those of reference group,and the platelet count of experimental group was higher than that of reference group(P<0.05).After treatment,the levels of CK-MB and total bilirubin in two groups were decreased,and the level of CK-MB in experimental group was lower than that in reference group(P<0.05).The service life of filter in experimental group was longer than that in reference group(P<0.001).After treatment,the levels of blood urea nitrogen and creatinine were decreased,and the levels of HCO3-were increased in both groups,the levels of Ca2+and HCO3-in experimental group were lower than those in reference group(P<0.05).Conclusion:The anticoagulant effect of sodium citrate on CRRT in patients with severe sepsis thrombocytopenia is better,which can reduce renal function injury,reduce CK-MB level,prolong the service life of filter and maintain electrolyte balance.