枸橼酸钠抗凝在血液透析滤过治疗中的效果观察

Effect of sodium citrate anticoagulation in Hemodiafiltration

目的探讨动静脉端同时泵入枸橼酸钠抗凝在血液透析滤过(HDF)治疗中的有效性和安全性。方法选择武汉大学中南医院肾内科血液净化中心于2017年7月至2018年6月间有活动性出血或出血倾向的患者60例作为研究对象,使用4%枸橼酸钠体外局部抗凝,在动静脉端分别泵入,同时调节透析液离子浓度,密切监测血气分析,记录患者生命体征、体外循环管路及透析器的凝血情况。结果 (1)60例患者114次HDF4 h治疗均完成,其中Ⅰ级凝血发生8例,Ⅱ级凝血发生2例;(2)治疗前、治疗2 h、治疗结束时血气分析结果中pH值、PCO_2、HCO_3^-、BE、Na^+、外周游离钙较治疗前上升,但在正常范围内,差异有统计学意义(P<0.05);(3)患者治疗过程中生命体征平稳,未有患者出现口唇、面部、指尖麻木及手足抽搐等临床症状;(4)60例患者114次治疗均未出现因枸橼酸钠抗凝导致的原有出血加重及新发出血事件。结论采用动静脉端同时泵入枸橼酸钠并辅以调节透析液离子浓度的方法,对有出血情况或出血倾向患者进行含钙透析液HDF治疗安全有致;治疗时需要严密监测血气分析变化,并根据血气分析变化调节透析液离子浓度。

Objective To investigate the efficacy and safety of sodium citrate pumping in both side of arteriovenous end in Hemodiafiltration.Methods From July 2017 to June 2018,60 patients,came from blood purification center of nephrology department in Zhongnan hospital of Wuhan university,who had active bleeding or bleeding tendency,were selected to the research object.Using the local anticoagulation,4% sodium citrate in vitro in arteriovenous end pumping,respectively,at the same time adjust the dialysate ion concentration,close monitoring of blood gas analysis,records of the patient’s vital signs,extracorporeal circulation line and dialyser coagulation conditions.Results 1、60 patients with 114 HDF about 4 hours treatment are completely finished,including blood coagulation withⅠmagnitude about 8 cases of,grade Ⅱcoagulation occurred in 2 cases;2,the pH value,PCO2,HCO3-,BE,Na+ and peripheral free calcium in the blood were tested before treatment,2 hours after treatment and at the end of treatment,the value were all increased compared with the first time,but still in the normal range,the difference was statistically significant(P<0.05).3,the patient’s vital signs were stable during the treatment,no patient had clinical symptoms such as mouth,face,fingertip numbness and hand twitch.4,none of the 60 patients with 114 times of treatment showed increased and new bleeding events caused by sodium citrate anticoagulation.Conclusion Regional citrate anticoagulation in both arteriovenous end and supplemented by the method of regulating the ion concentration of dialysate,can safely and effectively satisfied with the patients with bleeding or bleeding tendency for the treatment of HDF.It is necessary to closely monitor the changes of blood gas analysis and adjust the ion concentration of dialysate according to the changes of blood gas analysis.