摘要
目的探讨简化枸橼酸抗凝(RCA)在高出血风险患者血液透析(HD)中的价值。方法纳入64例高出血风险HD患者,收集其一般临床资料及透析治疗中的临床资料,包括动脉端泵入体外循环的枸橼酸钠量、透析中血压、管路动静脉压、跨膜压及透析前(0 h)、透析2 h、透析4 h游离钙水平、透析器凝血分级及发生不良事件情况、透析前及透析后血红蛋白、肝肾功能、电解质、尿素清除指数(KT/V)、凝血功能。结果64例患者共行400例次RCA-HD治疗,共396例次完成预定4 h透析治疗,抗凝有效率为99%。枸橼酸用量与透析2 h血游离钙水平呈负相关(P<0.05)。简化RCA-HD治疗前、后患者血红蛋白、白蛋白、游离钙、血磷、血钾、HCO 3-、血肌酐、尿素、KT/V、血小板计数、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)比较差异无统计学意义(P>0.05)。结论简化RCA-HD治疗方案在高出血风险患者HD中安全简便,可满足4 h透析需求。
Objective To investigate the value of simplified regional citrate anticoagulation(RCA)in hemodialysis(HD)patients with high-risk bleeding.Methods A total of 64 HD patients with high-risk bleeding were enrolled.General clinical data and clinical data in dialysis were collected,including artery end pumping extracorporeal circulation amount of sodium citrate,blood pressure,pipeline arteriovenous pressure,transmembrane pressure during dialysis,the free calcium levels before dialysis(0 h),2 h,and 4 h,dialyzer coagulation grading and adverse events,and the levels of hemoglobin,liver and kidney function,electrolyte,urea clearance index(KT/V),coagulation function before and after dialysis.Results A total of 400 cases RCA-HD treatments were performed in 64 patients,396 cases completed the scheduled 4 h dialysis treatment,the anticoagulant efficiency was 99%.There was a negative correlation between the amount of citrate and the level of blood free calcium during 2 h of dialysis(P<0.05).There were no significant differences in hemoglobin,albumin,free calcium,serum phosphorus,serum potassium,HCO 3-,serum creatinine,urea,KT/V,platelet count,prothrombin time(PT),activated partial thrombin time(APTT)between the patients before and after RCA-HD treatment(P>0.05).Conclusion Simplified RCA is safe,simple,effective and can satisfy the sufficiency of dialysis in HD patients with high-risk bleeding.
作者
张少岩
李月红
杨画
王炜
武向兰
Zhang Shaoyan;Li Yuehong;Yang Hua;Wang Wei;Wu Xianglan(Department of Nephrology,Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing 102218,China)
出处
《临床内科杂志》
CAS
2021年第1期34-36,共3页
Journal of Clinical Internal Medicine
基金
首都临床特色应用研究(Z181100001718129)。
关键词
简化枸橼酸抗凝
血液透析
出血风险
透析充分性
Simplified regional citrate anticoagulation
Hemodialysis
High-risk bleeding
Dialysis adequacy
