摘要
目的 研究局部枸橼酸抗凝在血液透析 (HD)、连续性静静脉血液滤过 (CVVH)及血液透析滤过(HDF)中的应用 ,以期得到针对不同血液净化方式更安全、有效、简便的局部枸橼酸抗凝方案。方法 选择 5 6例患者分为 2组 :局部枸橼酸抗凝组 (RCA组 ) 4 6例 ,行血液净化 86例次 ;对照组 10例 ,行无肝素或小剂量肝素血液净化 39例次。监测全血ACT(活化凝血时间 )、观察体外循环凝血情况 ;监测血清游离钙、枸橼酸、血钠、碳酸氢根浓度 ;监测血尿素氮、肌酐等。结果 RCA组 :治疗中体外ACT较治疗前延长 39%～75 % (P <0 .0 1) ,体内ACT较治疗前无延长 ;透析器凝血程度达 2～ 3级的比对照组明显减少 ,静脉壶凝血的发生率 (除血液透析滤过以外 )比对照组明显减少。体内血游离钙水平无明显改变 ,血清枸橼酸水平始终处于安全范围内 ,未发生高钠血症和代谢性碱中毒并发症。血尿素氮、肌酐等清除理想。结论 不同血液净化方式的局部枸橼酸抗凝体外抗凝确切 ,对系统凝血功能无影响 ;无各种并发症 ;且血液净化效果好。应用局部枸橼酸抗凝技术行HD、CVVH及HDF治疗高危出血倾向患者既简便易行 ,又安全有效。
Objective To investigate the application of regional citrate anticoagulation to hemodialysis (HD), continuous venovenous hemofiltration (CVVH) and hemodiafiltration (HDF) in order to find a safe effective and simple regional anticoagulation method. Methods Fifty-six patients were divided into 2 groups: 46 patients in regional citrate anticoagulation (RCA) group were treated with 86 blood purification sessions, and 39 sessions for 10 patients in control group using without or low-dose heparinization. The Activated coagulation time (ACTs) and the efficiency of extracorporeal coagulation were observed. The serum ionized calcium, citrate, bicarbonate, sodium, serum creatinine and urea concentration. were monitored. Results RCA group: the ACTs of the extracorporeal circuit remained approximately 39%～75%(P<0.01) above the baseline ACT, and the ACTs of the systemic blood remained in the pretreatment range. Dialyzer clotting occurred less than in control group. And clotting in venous drip chamber occurred also less than in control group (except in hemodiafiltration). The serum ionized calcium concentration remained in normal range. The citrate level was in safe range. Hypernatremia and metabolic alkalosis did not occur. The clearance of serum creatinine and urea was ideal. Conclusion The application of regional citrate anticoagulation to various forms of blood purification was shown to be effective, and systemic anticoagulation did not occur. Complications were not found. The effect of this treatment was ideal. Using regional citrate anticoagulation during HD, HDF and CVVH was simple, safe and effective for patients with increased risk of bleeding.
出处
《中国血液净化》
2004年第3期129-135,共7页
Chinese Journal of Blood Purification
关键词
枸橼酸
抗凝治疗
HD
血液净化
连续性静静脉血液滤过
CVVH
并发症
Regional citrate anticoagulation
Blood purification
Hemodialysis
Continuous venovenous hemofiltration
Hemodiafiltration
