枸橼酸抗凝在血液透析高危出血患者中的应用

庞娟

[摘要]目的 探讨高危出血患者血液透析中应用枸橼酸抗凝的效果。方法 选取2017年10～12月我院收治的80例维持性血液透析伴有出血或出血倾向的患者作为研究对象，随机分为两组，每组40例。对照组予以无肝素透析，观察组予以4%枸橼酸钠抗凝，观察透析器凝血情况、相关生化指标在治疗前后的变化情况及尿素清除指数（Kt/V）、尿素氮下降率（URR）、部分凝血活酶时间（APTT）、实际超滤量情况。结果 观察组患者透析器凝血情况优于对照组，差异有统计学意义（P<0.05）；透析后，两组BUN、SCr值低于治疗前，差异有统计学意义（P<0.05）；观察组透析后的BUN、SCr值低于对照组，差異有统计学意义（P<0.05）；两组pH值、Ca2+、K+比较，差异无统计学意义（P>0.05）；观察组的HCO3-值高于对照组，差异有统计学意义（P<0.05）；两组的Kt/V及URR比较，差异无统计学意义（P>0.05）；观察组的APTT低于对照组，差异有统计学意义（P<0.05）；观察组的实际超滤量高于对照组，差异有统计学意义（P<0.05）。结论 枸橼酸抗凝应用于血液透析高危出血倾向患者安全有效，不影响血液透析效果，具有推广价值。

[关键词]高危出血；枸橼酸抗凝；血液透析；应用效果

[中图分类号] R318.16 [文献标识码] A [文章编号] 1674-4721（2018）5（b）-0038-04

Application of citrate anticoagulation in hemodialysis patients with high-risk hemorrhage

PANG Juan

Zhuhai Branch of Guangdong People′s Hospital Jinwan Central Hospital of Zhuhai City，Guangdong Province，Zhuhai 519040，China

[Abstract]Objective To explore the clinical effect of citrate anticoagulation in hemodialysis patients with high-risk hemorrhage.Methods From October to December in 2017，80 maintenance hemodialysis （HD） patients complicated with hemorrhage bleeding tendency treated in our hospital were selected as the subject，and randomly divided into two groups，40 cases each group.The control group took the heparin-free hemodialysis.The observation group took the 4% citrate anticoagulation.The coagulation condition and biochemical indicators as well as the index of Kt/V，URR，APTT and actual ultrafiltration capacity were evaluated.Results The hemodialysis in idalyzer in the observation group was significantly better than that in the control group，the difference was statistically significant （P<0.05）.After HD，the index of BUN and SCr in the observation group were even lower than that in the control group，the difference was statistically significant （P<0.05）.Before and after HD，the value of PH，Ca2+ and K+ for two groups were not significantly different （P>0.05）.The value of HCO3- in the observation group was significantly higher than that in the control group，the difference was statistically significant （P<0.05）.The index of KT/V and URR for two groups were not significantly different （P>0.05）.The index of APTT in the observation group was significantly lower than that in the control group，the difference was statistically significant （P<0.05）.The actual ultrafiltration capacity in the observation group was significantly higher than，it has the value of promotion control group，the difference was statistically significant （P<0.05）.Conclusion For HD patients with high-risk hemorrhage，the citrate anticoagulation can improve the clinical safety and effect.In addition，the hemodialysis effect is not affected，it has the value of promotion.

[Keywords]High-risk hemorrhage；Citrate anticoagulation；Hemodialysis；Application effect

血液透析技术发展迅速，已成为救治急危重症患者重要的手段之一，而抗凝是保障血液透析顺利开展的条件和基础。临床上常见的抗凝剂为肝素，但其可使高危出血倾向患者发生高达10%～30%的并发症。传统的无肝素透析效果受到限制，且存在较多不安全的因素，因此寻找一种既能减少对患者损害，又能保证透析的充分性及较好的抗凝效果，降低并发症的抗凝技术尤为迫切。本研究旨在探讨4%枸橼酸抗凝在连续性血液净化高危出血患者中的应用效果，现报道如下。

1資料与方法

1.1一般资料

选取2017年10～12月我中心收治的80例维持性血液透析伴有出血或出血倾向的患者作为研究对象，随机分为对照组与观察组，每组各40例。观察组男25例，女15例；……