新型抗凝血透析液在高危出血肾衰患者血透中的抗凝效果

A new type concentrated anticoagulant hemodialysate on the high risk renal failure patients with bleeding

目的 研究新型枸橼酸盐浓缩抗凝血液透析液在高危出血肾衰患者血液透析临床应用的抗凝效果。方法 3 8例患者按抗凝方式分为二组 :Ⅰ组无肝素血液透析 ;Ⅱ组枸橼酸盐透析液血液透析。透析期间观察患者出血、体外循环凝血、游离钙、ACT和静脉压变化 ,并用扫描电镜观察滤器中空纤维内膜纤维蛋白沉积和血细胞聚集情况。结果 Ⅰ组 18例中 12例静脉压升高 ,7例透析器及管路发生严重凝血 ,未完成 4h血液透析。Ⅱ组 2 0例静脉端ACT明显延长 ,游离钙明显下降 ,动脉端ACT和游离钙正常 ,透析器及管路无严重凝血 ,全部完成 4h透析。

Objective To observe the anticoagulant effect of the new type of concentrated anticoagulant hemodialysate of citrate on the high risk renal failure patients with bleeding. Methods 38 patients were divided into 2 groups according to hemodialysis manners. Group Ⅰ was Saline-flush hemodialysed with bicarbonate hemodialysate, Group Ⅱ was hemodialysed with cirate hemodialysate without any anticoagulant. ACT, iCa 2+ regional bleeding and coagulation of extracorporeal circulation as well as venous blood pressure were monitored during hemodialysis, and a scanning electron microscopic (SEM) analysis was used to investigate the morphology of thrombus formation and cellular aggregation on the interior surfaces of hemodialysis membranes. Results During the hemodialysis in group Ⅰ, venous blood pressure increased continiously, resulting in the failure of hemodialysis for 4 hours in 7 out of 20 patients. Hemodialysis for 4 hours in Group Ⅱ were all successfully fulfiled. There was no instance bleeding. No sever clotting of dialyzers and blood lines was observed. During hemodialysis ACT was extended and free Ca 2+ decreased obviously in the venous end. But Ca 2+ and ACT in arlery end was normal. There was no thrombus in the hollow fibers. Conclusion The anticoagulant effect of the new type of concentrated anticoagulant hemodialysate of citrate was satisfactory and better than that of Saline-flush.