摘要
目的探讨应用局部枸橼酸抗凝法(RCA)对高危出血倾向患者行改良连续性静-静脉血液滤过(CVVH)治疗的可行性和安全性。方法将19例(68例次)具有高危出血倾向行CVVH治疗的患者随机分为观察组(34例次)和对照组(34例次)。对照组采用传统无肝素生理盐水冲洗法,观察组采用体外局部枸橼酸抗凝法。比较两组患者的出血情况、治疗时间、实际超滤量、各种生化指标及体外循环凝血情况。结果两组透析器凝血、静脉壶凝血情况、治疗前后血肌酐、尿素氮以及治疗时间和实际超滤量比较,差异有显著性意义(P<0·05,P<0·01);观察组治疗前后血清游离钙、钠、碳酸氢根浓度及体外活化凝血时间(ACT)比较,差异无显著性意义(均P>0·05);68例次治疗过程中无1例次发生体外循环凝血,19例患者无1例诱发或加重出血,均未发生并发症。结论应用局部枸橼酸抗凝法对高危出血倾向患者行CVVH治疗安全有效,护理中需注意监测患者各项指标,保证治疗的顺利进行。
Objective To evaluate the safety and clinical value of regional citrate anticoagulation （RCA） to continuous venovenous hemofiltration （CVVH） for patients with a high risk of bleeding. Methods Sixty-eight sessions continuous venovenous hemofiltration of the 19 patients with a high risk of bleeding were randomly divided into two groups： In the experiment group, 34 sessions were treated in regional citrate anticoagulation, while 34 sessions in control group using traditional rinse normal saline without heparinization. The efficiency of extracorporeal coagulation, treatment time, ultrafiltration value, serum creatinine and urea concentration in the two groups were compared. Results There was significant difference in the efficiency of extracorporeal coagulation, treatment time, ultrafiltration value, serum creatinine and urea concentration between experiment group and control group （P〈0.05, P〈0.01 ）. In the experiment group, the serum ionized calcium concentration remained in normal range,the citrate level was in safe range, hypernatremia and metabolic alkalosis did not occur. Conclusion RCA is a safe and effective method for patients with a high risk of bleeding.
关键词
肾衰竭
高危出血倾向
枸橼酸
抗凝
连续静-静脉血液滤过
护理
renal failure
a high risk of bleeding
citrate
anticoagulation
continuous venovenous hemofiltratio
nursing care
