摘要
目的探讨局部枸橼酸抗凝对老年终末期肾脏病维持性血液透析患者肾功能、凝血功能及体外循环凝血的影响。方法选取本院2016年1月至2018年6月收治的老年终末期肾脏病维持性血液透析患者86例为研究对象,按照随机数表法将入选患者分为对照组与观察组,每组各43例。对照组患者采用低分子肝素钠抗凝,观察组患者采用局部枸橼酸抗凝。比较两组患者治疗前和治疗24 h后凝血功能、肾功能、体外循环凝血情况及出血并发症发生情况。结果两组患者治疗24 h后血小板和纤维蛋白原水平与本组治疗前比较均无显著差异(P_均> 0.05),血小板和纤维蛋白原水平组间比较均无显著差异(P_均>0.05)。治疗24 h后,两组患者血肌酐和血尿素氮水平较治疗前均显著降低(P_均<0.05),观察组患者治疗24 h后血肌酐和血尿素氮水平均显著低于对照组(P_均<0.05)。观察组体外循环凝血程度Ⅰ～Ⅱ级患者占比显著高于对照组(P <0.05),Ⅳ级患者占比显著低于对照组(P <0.05)。两组患者透析后均未出现出血并发症。结论局部枸橼酸抗凝可减轻老年终末期肾脏病维持性血液透析患者体外循环凝血程度,改善肾功能,但对患者凝血功能无明显影响。
Objective To investigate the effect of local Citric acid anticoagulation on renal function,coagulation function and cardiopulmonary bypass coagulation in elderly patients with end-stage renal disease undergoing maintenance hemodialysis.Method 86 elderly patients with end-stage renal disease undergoing maintenance hemodialysis admitted to our hospital from January 2016 to June 2018 were selected as the study subjects.They were divided into control group and observation group according to the random table method,43 cases in each group.Control group patients were treated with low molecular weight heparin sodium anticoagulation,while observation group patients were treated with local Citric acid anticoagulation.The changes of coagulation function,renal function,coagulation during cardiopulmonary bypass and bleeding complications were compared between the two groups before treatment and 24 hours after treatment.Result There were no significant differences in platelet and fibrinogen levels in the two groups before and 24 hours after treatment(Pall>0.05),and there were no significant differences in platelet and fibrinogen levels between the two groups 24 hours after treatment(Pall>0.05).24 hours after treatment,the serum creatinine and urea nitrogen levels in both groups were significantly lower than those before treatment(Pall<0.05),and the serum creatinine and urea nitrogen levels in observation group were significantly lower than those in control group(Pall<0.05).The proportion of coagulation grade Ⅰ~Ⅱ in observation group was significantly higher than that in control group(P<0.05),and the proportion of grade Ⅳ in observation group was significantly lower than that in control group(P<0.05).No hemorrhagic complications occurred in both groups after dialysis.Conclusion Local anticoagulation with Citric acid can reduce the degree of cardiopulmonary bypass coagulation and improve renal function in elderly patients with end-stage renal disease undergoing maintenance hemodialysis,but there is no significant effect on coagulation function.
作者
冉梦晓
陈辉
RAN Meng-xiao;CHEN Hui(Department of Nephrology Hemodialysis Center,West China Hospital of Sichuan University,Chengdu 610041,China)
出处
《中国医学前沿杂志（电子版）》
2019年第4期49-52,共4页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
基金
四川省医药卫生科技项目(201720031)
关键词
枸橼酸
局部抗凝
终末期肾脏病
维持性血液透析
体外循环凝血
Citric acid
Local anticoagulation
End-stage renal disease
Maintenance hemodialysis
Extracorporeal circulation coagulation
