摘要
目的研究商品化枸橼酸-葡萄糖抗凝溶液A(ACD-A液)应用于急性肾衰竭伴出血倾向高危患者连续性血液净化(CBP)抗凝的疗效及安全性。方法 12例伴出血或出血倾向患者行连续性静脉-静脉血液滤过(CVVH),分为局部枸橼酸抗凝(RCA)组和对照组。RCA组共 38例次,应用ACD-A液为抗凝剂自滤器前输入;于血路管的静脉侧补充10％葡萄糖酸钙。 ACD-A液及钙剂输入速度根据血清及滤器后离子钙(iCa2+)水平调整以维持滤器后iCa2+0．30- 0．40 mmol／L．血清iCa2+0．9-1．2 mmol／L。对照组应用小剂量低分子肝素钠(1700-2500 IU,每 12～24 h 1次)或不使用抗凝剂。比较两组血滤器使用时间;监测RCA组治疗前后血浆凝血酶原时间(PT)和部分凝血活酶时间(APTT)、酸碱变化及血清iCa2+、钠离子(Na+)水平。结果 RCA 组和对照组CBP总治疗时间分别为1192．5 h、596 h,各使用血滤器62个、42个。24 h和48 h 血滤器的可使用率分别为:RCA组65．3％和24．5％;对照组14．5％和0。达使用终点的血滤器平均寿命,RCA组显著长于对照组[(29．4±21．0)(1．5-71．5)h比(14．2±8．2)(4．5-40)h,P<0．01]。 ACD-A抗凝治疗中,血PT、APTT、pH、碱剩余、iCa2+、Na+水平较治疗前基本保持不变;无1例次出血加重或新发出血、无1例次诱发肢体抽搐。结论 ACD-A液抗凝剂在有效监测的情况下,应用于伴出血倾向患者的CBP,是一种简便易行、安全有效的方法,有一定的临床应用及推广价值。
Objective To evaluate the effect and safety oi anticoagnlant citrate dextrose solution A （ACD-A） in continuous blood purification （CBP） for patients at high risk of bleeding with ARF. Methods Twelve patients at high risk of bleeding, treated with continuous venovenous hemofdtration （CWH）, were divided into regional citrate anticoagulant （RCA） group and control group. In the former, ACD-A solution was delivered, pre-filter , with the rate adjusted to maintain a postfilter ionized calcium （iCa2.） level between 0.30～0.40 mmol/L. Before the extracorpereal blood returned to the patient, 10% calcium gluconate was infused to maintain a systemic iCa2. level between 0.90-1.20 mmol/L. In control group, CVVH were performed either with low dose of heparin LMW sodium （1700-2500 IU/12 h-24 h）or without anticoagulant. The life span of each hemofilter was recorded. In RCA group, prothrombin time （PT）, activated partial thromboplastin time （APTT）, acid-base changes, serum sodium and iCa^2＋ were monitored pre- and during CVVH. Result In the whole duration 1192.5 hours of CVVH in RCA group and 596 hours in control group, 62 and 42 hemofdters were used, respectively. Filter survival was 65.3% at 24 h and 24.5% at 48 h in RCA group,while 14.5% and 0 in control group. The mean life span of fdter in RCA group was significandy longer than that in control greup[（29.4±21.0） （1.5-71.5）h vs（14.2±8.2）（4.5-40）h, P 〈 0.01 ]. During 38 sessions of CVVH with ACD-A solution anticoagulation, PT, APTT, acid-beso status,serum iCa^2＋ and sodium showed subtle changes, compared with pre-CWH.There were no significant bleeding events and no muscular spasms induced by ACD-A solution. Conclusion ACD-A solusion as anticoagulant during CBP is safe, convenient and effective for patients at high risk of bleeding with ARF.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2006年第3期166-169,共4页
Chinese Journal of Nephrology
