摘要
目的:为了探索枸橼酸局部抗凝血液透析(RCA-HD)时,动脉管路血游离钙浓度(A管iCa)与外周静脉血游离钙浓度(PiCa)的函数关系,以便用动脉管路血游离钙检测值替代外周静脉血游离钙数值。方法:选取2014年10月-2016年2月本院行血液透析的急慢性肾功能衰竭患者46例,4%枸橼酸钠由透析器前动脉端泵入,含钙(1.75 mmol/L)碳酸氢盐透析液及空心纤维透析器,透析前低钙者分梯次补钙。RCA-HD时同步在动脉管路输入枸橼酸前和外周静脉内采集血标本,将iCa值对比,观察RCA的效果及安全性,如凝血、出血及低钙血症等。结果:46例急慢性肾功能衰竭患者,共进行51次RCA-HD。统计显示,动脉管路内与外周肢体静脉化验值比较差异有统计学意义(P<0.05),两组数据高度正相关,r=0.924,回归方程:PiCa=0.11+0.908×A管iCa,r=0.935;透析过程中无管路、透析器凝血、诱发或加重出血者。结论:临床实践中可以用A管iCa值经换算代替Pi Ca值。RCA-HD安全,效果满意,推荐扩大梯次补钙的临床实践。
Objective： To explore the relationship between different ionized calcium （ iCa ） concentrations in arterial line and peripheral vein of regional citrate anticoagulation hemodialysis （ RCA-HD ） for application. Method： From October 2014 to February 2016, 46 cases of acute or chronic renal failure patients in our hospital were selected.4% sodium citrate was infused into the arterial line before dialyzer, calcium bicarbonate dialysate （ 1.75 mmol/L ）, hollow fiber dialyzer and low calcium points arrangement in filling calcium.The additional calcium supplementation was administered in the way of echelon according to pre-HD blood iCa level.Blood sample was collected from the arterial line before the infusion of citrate and from the peripheral vein.The data of the two groups were analyzed to observe the difference between iCa concentration levels in the arterial line and in peripheral vein, the anticoagulant effect of RCA and possible complications, such as bleeding and hypoealcaemia. Result： Among 46 cases of acute and chronic renal failure patients with active bleeding and high risk of bleeding tendency, 51 times of RCA-HD performed.Statistics showed that, arterial line and peripheral compared difference was statistically significant （P〈0.05）, regression test r=0.924, there was correlation between the two sets of data.The regression equation： PiCa=0.11 ＋ 0.908× A tube of iCa, r=0.935.None induced bleeding, or bleeding aggravated, blood calcium concentration was controlled in the ideal range.Conclusion： In clinical practice, the value of arterial line iCa concentration can be used to replace the value of iCa concentration in peripheral blood. RCA-HD therapy is safe and effective.Calcium supplementation in the way of echelon is recommended expanding.
出处
《中国医学创新》
CAS
2016年第27期120-123,共4页
Medical Innovation of China
