摘要
目的探究长时间枸橼酸抗凝治疗在维持性血液透析患者中的有效性及安全性。方法选取2016年1月至2019年12月于上海市第九人民医院血液净化室进行血液透析的具有高危出血倾向的26例患者作为研究对象,且均进行枸橼酸抗凝维持时间>3个月,观察患者在治疗期间的临床症状、不良反应及滤器、管路的凝血情况,定期检测透析前后患者体内的凝血情况、电解质(血钠、血钾、血氯、血钙、血镁)及相关生化指标(甲状旁腺激素、碱性磷酸酶、脂蛋白)的变化,并分析进行枸橼酸抗凝治疗前后患者体内骨代谢变化情况。结果患者对枸橼酸抗凝耐受性良好,没有严重并发症发生。在总计1612例次血液透析中,所有治疗没有出现因滤器或管路凝血而中断治疗的情况,只有在透析结束后发现11次滤器有2级凝血,总的抗凝有效性达到99.31%;在透析后静脉壶中发现少许血凝块也只有3.72%(60/1612)。单次透析前后患者的凝血功能(凝血酶原时间、活化部分凝血酶原时间)、血钠、血清游离钙和总钙、血镁无明显变化(P>0.05),但血肌酐、血钾明显降低,而血氯、血清碳酸氢根则增高(P<0.05)。透析3个月、6个月后患者体内的血钙、甲状旁腺激素、碱性磷酸酶的变化均无显著差异(P>0.05)。结论枸橼酸抗凝可以长期在维持性血液透析中开展,且疗效良好、安全性高,具有广阔的应用前景。
Objective To explore the effectiveness and safety of long-term citrate anticoagulant therapy in maintenance hemodialysis patients.Methods Twenty-six patients with high-risk bleeding tendency who underwent hemodialysis in the blood purification room of Shanghai Ninth People’s Hospital from January 2016 to December 2019 were selected,and all of them were treated with citrate anticoagulation for more than 3 months.We observed the clinical symptoms,adverse reactions and blood coagulation in the filter and pipeline during the treatment.The changes of coagulation indexes,electrolytes(blood sodium,potassium,chlorine,calcium,magnesium)and related biochemical indexes(parathyroid hormone,alkaline phosphatase,lipoprotein)were measured regularly before and after dialysis.We also analyzed the changes of bone metabolism in patients before and after citrate anticoagulant therapy.Results The patient had a good tolerance to citric acid anticoagulation and no serious complications occurred.In a total of 1612 cases of hemodialysis,all treatments were not interrupted due to coagulation in the filter or pipeline.The filters were found to have only grade 2 blood clotting after the end of dialysis in 11 times of dialysis,and the total anticoagulant effectiveness reached 99.31%.Only 3.72%of the dialysis cases in the venous kettle were founded a few blood clots after dialysis which accounted for 3.72%(60/1612).There were no significant changes in blood coagulation function(PT,APTT),serum sodium,magnesium,free calcium and total calcium before and after single dialysis(P>0.05);but serum creatinine and potassium decreased significantly,while chlorine and HCO-3 increased(P<0.05).There was no significant difference in the changes of calcium,parathyroid hormone and alkaline phosphatase after 3 months and 6 months of dialysis(P>0.05).Conclusions Citrate anticoagulation can be carried out in maintenance hemodialysis for a long time.It has good curative effect and high safety,and has a broad application prospect.
作者
庄峰
毕逍
丁峰
ZHUANG Feng;BI Xiao;DING Feng(Department of Nephrology,the Ninth People's Hospital,Shanghai Jiaotong University,200011 Shanghai,China)
出处
《临床肾脏病杂志》
2020年第9期740-744,共5页
Journal Of Clinical Nephrology
基金
上海浦东新区卫计委联合攻关项目(PW2015D-4)。
关键词
枸橼酸抗凝
血液透析
出血倾向
Hemodialysis
Local citrate anticoagulation
Bleeding tendency
