局部枸橼酸钠抗凝技术在重症监护病房高出血风险患者血液净化治疗中的作用

发布时间：2018-01-20 13:29

本文关键词： 局部枸橼酸钠抗凝血液净化出血风险　出处：《中南大学学报(医学版)》2016年12期 　论文类型：期刊论文

【摘要】：目的:探讨局部枸橼酸钠抗凝技术在高危出血风险患者血液净化中的安全性和有效性。方法:将152例行连续血液净化治疗伴高出血风险的重症监护病房患者按时间段分为两组,A组(68例)采用肝素钠抗凝法,B组(84例)采用局部枸橼酸钠抗凝法。观察两组滤器、静脉壶的凝血情况,治疗前及治疗过程中滤器前后全血活化凝血时间及电解质等指标。结果:与A组比较,B组滤器和静脉壶凝血发生率及严重程度降低(P0.05),且患者新发出血和原有出血加重发生率也大大下降;A组滤器后活化凝血时间(activated clotting time,ACT)在治疗后各时间点较治疗前延长(P0.05),而B组滤器后的ACT浓度在治疗后各时间点与治疗前比较差异无统计学意义(P0.05);两组治疗后各时间点p H,Na+,HCO3 ,Ca2+浓度均维持在正常范围。结论:局部枸橼酸钠抗凝技术在连续血液净化治疗过程中可取得良好的局部抗凝效果,出血风险低,是高危出血风险患者理想的体外抗凝方法。
[Abstract]:Objective: to investigate the safety and efficacy of local sodium citrate anticoagulant technique in blood purification of patients with high risk of bleeding. 152 patients in intensive care unit who received continuous blood purification therapy with high risk of bleeding were divided into two groups according to the time period. Group A (n = 68) were treated with heparin sodium anticoagulant method and group B (n = 84). Local sodium citrate anticoagulant method was used. Results: compared with group A, the incidence and severity of filter and venous coagulation in group B were lower than those in group A (P 0.05). And the incidence of new bleeding and the original hemorrhage increased greatly. In group A, activated coagulation time and activated clotting time were prolonged at each time point after treatment (P0.05). However, there was no significant difference in the concentration of ACT between before and after treatment in group B (P 0.05). The two groups were treated at different time points after treatment. Conclusion: local sodium citrate anticoagulant technique can obtain good local anticoagulant effect and low risk of bleeding during continuous blood purification therapy. It is an ideal in vitro anticoagulant method for patients with high risk of bleeding.
【作者单位】：中南大学湘雅三医院急危重症医学中心;
【分类号】：R459.5
【正文快照】： Methods:One hundred and fi ft y-two patients at high risk of bleeding were divided into local citrategroup(group A,n=68)and heparin group(group B,n=84).Clotting function,change of p H,ionized sodium,bicarbonate ion,ionized calcium,activated clott ing tim

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