摘要
目的研究维持性血液透析伴发消化道出血治疗中局部枸橼酸钠抗凝对患者透析充分性与凝血功能的影响。方法回顾性分析2020年6月至2022年12月在本院收治的69例维持性血液透析伴发消化道出血患者的临床资料,按照抗凝方法分为A、B、C组,每组23例,A、B组采用4%枸橼酸钠单段式简化抗凝法,于血泵后滤器前泵入进行体外抗凝治疗,透析时间均为4 h,其中A组200 mL/h,B组300 mL/h;C组采用常规无肝素生理盐水冲洗法。比较三组患者的肾功能、凝血功能、抗凝效果、透析时间、完成率以及透析充分性。结果治疗后,三组患者的血清肌酐(Scr)、尿素氮(BUN)水平低于治疗前,差异均有统计学意义(均P<0.01);B组患者的血清Scr、BUN水平低于A、C组,差异均有统计学意义(均P<0.001)。B组滤器的抗凝有效率高于A、C组,差异有统计学意义(95.65%vs.82.61%vs.60.87%,P<0.001);B组静脉壶的抗凝有效率高于A、C组,差异有统计学意义(82.61%vs.69.57%vs.47.83%,P<0.05)。与A组和C组比较,B组的透析完成率与透析时间最优,差异均有统计学意义(均P<0.05);B组患者透析后的溶质清除指数(Kt/V)、尿素清除率(URR)高于A、C组,差异均有统计学意义(均P<0.05)。结论局部枸橼酸钠抗凝在维持性血液透析伴发消化道出血治疗中的应用价值高于常规无肝素生理盐水冲洗法,且高剂量枸橼酸钠效果优于低剂量枸橼酸钠,可改善肾功能,提升临床抗凝效果、透析充分性、透析完成率,且对患者凝血功能无影响。
Objective To study the effect of local citric acid anticoagulation on dialysis adequacy and coagulation function in maintenance hemodialysis patients with gastrointestinal bleeding.Methods The clinical data of 69 patients with maintenance hemodialysis with gastrointestinal bleeding admitted to our hospital from June 2020 to December 2022 were retrospectively analyzed and divided into groups A,B and C,23 cases in each group.Group A and B used 4%sodium citrate simplified anticoagulant method.The dialysis time was 4 h,200 mL/h in group A and group B in 300 mL/h.Group C used conventional heparin free saline irrigation method.Renal function,coagulation function,anticoagulation effect,dialysis time,completion rate,and dialysis adequacy were compared in the three groups.Results After treatment,the differences in serum creatinine(Scr)and urea nitrogen(BUN)were lower than those before treatment(all P<0.01).The serum Scr and BUN levels in group B were lower than those in group A and C,respectively(all P<0.001).The filters in group B were higher than in A and C(95.65%vs.82.61%vs.60.87%,P<0.001)and higher in group B than in A and C(82.61%vs.69.57%vs.47.83%,P<0.05).Compared with group A and group C,the optimal dialysis completion rate and dialysis time in group B were statistically significant(all P<0.05).The solute clearance index(Kt/V)and urea clearance(URR)in group B were higher than that of group A and C,respectively(all P<0.05).Conclusions The application value of local citric acid anticoagulation in the treatment of digestive tract bleeding accompanied by maintenance hemodialysis is higher than that of conventional normal saline irrigation without heparin,and the effect of high-dose sodium citrate is better than that of low-dose sodium citrate,which can improve renal function,improve clinical anticoagulation effect,dialysis adequacy and completion rate,and the coagulation function of patients has no influence.
作者
刘琳
郑悦
董娟
鲍继琳
李盛婧
赵木才
Liu Lin;Zheng Yue;Dong Juan;Bao Jilin;Li Shengjing;Zhao Mucai(Department of Nephrology,Panzhihua Central Hospital,Panzhihua 617067,China)
出处
《国际泌尿系统杂志》
2024年第2期314-318,共5页
International Journal of Urology and Nephrology
基金
攀枝花市2021年度市级指导性科技计划项目(2021ZD-S-14)。
关键词
消化道出血
维持性血液透析
枸橼酸钠
血液凝固
透析充分性
Hemorrhage of Digestive Tract
Maintenance Hemodialysis
Sodium Citrate
Blood Coagulation
Adequacy of Dialysis
