局部枸橼酸抗凝技术应用于中毒患者血液灌流的效果及出血并发症分析

Clinical Effect of Regional Citrate Anticoagulation in Hemoperfusion of Poisoned Patients

目的分析重症监护室(ICU)中毒患者血液灌流中应用局部枸橼酸抗凝(RCA)技术治疗的效果及其出血并发症情况。方法选择2015年2月-2019年2月漯河市第三人民医院收治的中毒患者60例进行分组研究,以随机双盲法分为两组,每组30例。对照组血液灌流中用低分子肝素抗凝(LMWH),观察组则用RCA技术。评价血液灌流器凝血情况,测定治疗前后血小板计数、凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(Fib),记录出血并发症。结果观察组血液灌流器Ⅰ级凝血率显著高于对照组(P <0.05);两组治疗前血小板计数、PT、APTT、Fib对比无显著差异(P> 0.05),治疗后观察组血小板计数与Fib显著高于对照组,而PT与APTT显著低于对照组(均P <0.05);观察组出血并发症发生率显著低于对照组(P <0.05)。结论 RCA技术应用在ICU中毒患者血液灌流中,相比LMWH而言,可以避免血液灌流器凝血,减少出血并发症,且对血小板计数、PT、APTT、Fib等指标干扰更小,值得临床应用。

Objective To analyze the therapeutic effect of regional citrate anticoagulation(RCA)in hemoperfusion for patients with poisoning in intensive care unit(ICU).Methods 60 cases of poisoning patients admitted to ICU of Luohe Third People’s Hospital from February 2015 to February 2019 were selected and divided into two groups with 30 cases in each group by random double blind method.Low molecular weight heparin(LMWH)was used in hemoperfusion in the control group,while RCA was used in the observation group.The coagulation status of hemoperfusion device was evaluated,platelet count,prothrombin time(PT),activated partial thromboplastin time(APTT)and fibrinogen(Fib)were measured before and after treatment,and bleeding complications were recorded.Results The blood coagulation rate of hemoperfusion device I in the observation group was significantly higher than that in the control group(P<0.05).There was no significant difference in platelet count,PT,APTT and Fib between the two groups before treatment(P>0.05).After treatment,platelet count and Fib in the observation group were significantly higher than those in the control group,while PT and APTT were significantly lower than those in the control group(all P<0.05).The incidence of bleeding complications in the observation group was significantly lower than that in the control group(P<0.05).Conclusion Compared with LMWH,RCA technology can avoid coagulation of hemoperfusion device,reduce bleeding complications,and has less interference on platelet count,PT,APTT,Fib and other indicators.It is worthy of clinical application.