枸橼酸钠抗凝在危重烧伤患者连续性肾脏替代治疗中的应用及护理

夏青青　邓雪辉

[摘要] 目的 觀察、分析在危重烧伤患者连续性肾脏替代治疗中，总结并阐述枸橼酸钠抗凝在危重烧伤患者连续性肾脏替代治疗中的应用及护理效果。 方法 方便选取该院2016年1月—2017年1月间接收的危重烧伤患者30例作为研究对象；分为两组。每组15例，对照组应用预冲式枸橼酸钠杭凝治疗路径；实验组应用同步输入枸橼酸路径。观察分析两组的应用效果。 结果 实验组患者滤器、管路使用时间分别是（47.54±11.56），（41.65±11.32）h，对照组分别为（36.53±10.12），（34.45±10.41）h，两组之间对比，实验组显著优于对照组，差异有统计学意义（P<0.05）。实验组患者出血发生率为6.7%，显著低于对照组的40.0%，两组之间对比，实验组显著优于对照组，差异有统计学意义（P<0.05）。结论 在危重烧伤患者连续性肾脏替代治疗中，相比于应用预冲式枸橼酸钠杭凝治疗路径来说，应用同步输入枸橼酸路径的治疗效果更为显著，有效的降低患者出血发生率，缩短滤器、管路使用时间，安全性高，值得应用。

[关键词] 枸橼酸钠；抗凝；危重烧伤患者；连续性肾脏；替代治疗；护理

[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742（2018）04（c）-0127-03

Application and Nursing of Sodium Citrate Anticoagulation in the Continuous Renal Replacement Therapy of Severe Burn Patients

XIA Qing-qing1， DENG Xue-hui2

1.ICU， Xinjiang Uygur Autonomous Region Occupational Disease Hospital， Urumqi， Xinjiang， 830091 China；2.Department of Gynecology and Obstetrics， Xinjiang Uygur Autonomous Region Occupational Disease Hospital， Urumqi， Xinjiang， 830091 China

[Abstract] Objective To observe and analyze the application and nursing of sodium citrate anticoagulation in the continuous renal replacement therapy of severe burn patients. Methods 30 cases of severe burn patients admitted and treated in our hospital from January 2016 to January 2017 were convenient selected and divided into two groups with 15 cases in each， the control group and the experimental group were respectively treated with precharged sodium citrate anticoagulation and synchronization input sodium citrate anticoagulation， and the application effect of the two groups was observed and analyzed. Results The usage time of filter and pipeline in the experimental group and in the control group were respectively （47.54±11.56），（41.65±11.32）h and （36.53±10.12），（34.45±10.41）h， and the indicators in the experimental group were obviously better than those in the control group， and the differences were statistically significant（P<0.05）， and the incidence rate of hemorrhage in the experimental group was obviously lower than that in the control group（6.7% vs 40.0%）， and the indicator in the experimental group was obviously better than that in the control group， and the difference was statistically significant（P<0.05）. Conclusion The effect of synchronization input sodium citrate anticoagulation in continuous renal replacement therapy of severe burn patients is more obvious than that of precharged sodium citrate anticoagulation， which can effectively reduce the incidence rate of hemorrhage， and shorten the usage time of filter and pipeline， with high safety， and it is worth application.

[Key words] Sodium citrate； Anticoagulation； Severe burn patients； Continuous renal； Replacement therapy； Nursing

连续性肾脏替代治疗（CRRT）是血液净化中一种较新的技术，如今在重危疾病的治疗方面得到广泛的应用。随着我国的重症医学理论的不断进步与发展，在一些单一的功能器官上找到了多器官共同支持的理论依据，甚至可以做到替代的效果，因此也被作为一些器官在不同程度上的辅助作用。这项技术需要将患者體内的血液移至体外，因此治疗时间会比较长。所以，要想实现CRRT顺利进行，就必须做好血液抗凝，这是保证的关键环节。目前CRRT中最常用的抗凝剂是肝素，但肝素用于全身抗凝时易产生或加重出血、过敏性休克、血小板减少等不良反应。近年的研究发现，枸橼酸钠可与钙离子结合，起到局部抗凝的效果，而且枸橼酸钠进入体内后即进入三羧酸循环而被代谢，不会产生全身抗凝的作用，是血液透析抗凝治疗的一种非常理想的方法，尤其适用于有出血倾向的患者。……