两种不同抗凝方法在危重症患者连续性肾脏替代治疗中的比较研究
发布时间：2018-07-17 00:48
【摘要】：目的:连续性肾脏替代治疗(continuous renal replacement therapy CRRT)是危重症患者治疗领域的重大进步,它能够清除炎症介质、维持内环境稳定、替代肾脏功能。但安全有效的抗凝是CRRT顺利进行的重要保证,本研究旨在对低分子肝素和局部枸橼酸两种抗凝方法进行比较研究,以期为CRRT的抗凝治疗提供更好的依据和方案。方法:将行CRRT治疗的危重症患者随机分组为低分子肝素组(A组)和局部枸橼酸组(B组),均选择连续性静脉-静脉血液滤过(CVVH)模式,血管通路采用经股静脉置入12F16cm双腔中心静脉导管。CRRT应用PRISMA FLEX血滤机(GAMBRO)和AN69滤器(M100膜面积0.9m2),置换液3000ml/h,前置换75%,后置换25%,血流速度100-150ml/min。血液滤过开始前用含肝素钠1.25万单位的生理盐水2L预冲滤器及管路,开始引血时将含肝素钠的预冲液排出。低分子肝素组(A组):低分子肝素负荷量40IU/kg,随后持续泵入剂量4IU/kg/h。枸橼酸组(B组):初始枸橼酸钠泵速(ml/h)设置为血流速度的1.2-1.5倍,10%葡萄糖酸钙泵速为8.8-11.1ml/h(枸橼酸泵速的6.1%),根据滤器后离子钙调整枸橼酸用量,根据体内离子钙调整葡萄糖酸钙用量。监测滤器使用寿命、CRRT治疗前后的血液学指标、凝血功能指标、肝肾功能及代谢方面指标,并评价抗凝的有效性及安全性。结果:本研究共纳入67例患者,A组34例,B组33例,在CRRT治疗前A、B两组患者之间的年龄、体重、APACHEⅡ评分及肌酐清除率无明显统计学意义(P0.05)。在CRRT治疗前分别对两组的白细胞(WBC)、血红蛋白(HGB)、血小板(PLT)、凝血功能、肾功能及肝功能进行组间比较,均无明显统计学差异(P0.05)。A组中HGB在治疗后较治疗前有下降(P0.05),活化部分凝血活酶时间(APTT)在治疗后较前延长(P0.05),B组治疗前后HGB及APTT无显著变化(P0.05),但两组患者的PLT均较治疗前有下降(P0.05)。两组患者治疗后血肌酐及血尿素氮均较前下降(P0.05),组间比较无明显统计学差异(P0.05)。两组患者在治疗各时间点离子指标的组内及组间比较无明显统计学意义(P0.05),但血气指标比较有明显差异(P0.05)。滤器使用寿命用(均数±标准差)表示,低分子肝素抗凝组为33.76±13.56h,局部枸橼酸抗凝组为41.36±20.85h,枸橼酸组滤器寿命长于低分子肝素组,两组间比较P值为0.081(P0.05),无明显统计学差异。结论:1局部枸橼酸抗凝组的滤器寿命长于低分子肝素抗凝组,但统计学比较得出无统计学意义,所以可能仍需要大样本量及多中心的研究分析。2在两种抗凝方式下血液滤过均能有效清除血肌酐及血尿素氮。
[Abstract]:Objective: continuous renal replacement therapy (continuous renal replacement therapy CRRT) is an important progress in the field of critically ill patients. It can remove inflammatory mediators, maintain the stability of the internal environment, and replace renal function. However, safe and effective anticoagulation is an important guarantee for the smooth progress of CRRT. The purpose of this study is to compare the two anticoagulant methods of low molecular weight heparin and local citric acid in order to provide a better basis and scheme for the anticoagulant therapy of CRRT. Methods: the critically ill patients who were treated with CRRT were randomly divided into low molecular weight heparin group (group A) and local citrate group (group B). Continuous veno-venous hemofiltration (CVVH) was selected. The vascular pathway was treated with 12F16cm double central vena cava catheter. CRRT was used to apply Presta FLEX blood filter (gambro) and AN69 filter (M100 membrane area 0.9m2), the replacement fluid was 3000ml / h, the anterior replacement was 75cm, the posterior replacement was 2525ml / min, and the blood flow velocity was 100-150 ml / min. The preflushing fluid containing heparin sodium 12500 units of normal saline 2L preflushing filter and pipeline was used before the beginning of hemofiltration, and the preflushing solution containing heparin sodium was discharged when the blood was drawn. Low molecular weight heparin group (group A): low molecular heparin loading of 40 IUU / kg, and then continuously pumped into the dose of 4 IU / kg / h. In the citrate group (group B), the initial sodium citrate pump velocity (ml/h) was set to 1.2-1.5 times of the velocity of blood flow. The velocity of calcium gluconate pump was 1.2-1.5 times that of the velocity of citric acid pump. The rate of calcium gluconate was adjusted according to the ion calcium behind the filter and the dosage of calcium gluconate was adjusted according to the ion calcium in vivo. The blood parameters, coagulation function, liver and kidney function and metabolism were monitored before and after CRRT treatment, and the efficacy and safety of anticoagulant were evaluated. Results: there were 33 patients in group B and 34 patients in group A in this study. There was no significant difference in age, weight, Apache 鈪，
本文编号：2128292
[Abstract]:Objective: continuous renal replacement therapy (continuous renal replacement therapy CRRT) is an important progress in the field of critically ill patients. It can remove inflammatory mediators, maintain the stability of the internal environment, and replace renal function. However, safe and effective anticoagulation is an important guarantee for the smooth progress of CRRT. The purpose of this study is to compare the two anticoagulant methods of low molecular weight heparin and local citric acid in order to provide a better basis and scheme for the anticoagulant therapy of CRRT. Methods: the critically ill patients who were treated with CRRT were randomly divided into low molecular weight heparin group (group A) and local citrate group (group B). Continuous veno-venous hemofiltration (CVVH) was selected. The vascular pathway was treated with 12F16cm double central vena cava catheter. CRRT was used to apply Presta FLEX blood filter (gambro) and AN69 filter (M100 membrane area 0.9m2), the replacement fluid was 3000ml / h, the anterior replacement was 75cm, the posterior replacement was 2525ml / min, and the blood flow velocity was 100-150 ml / min. The preflushing fluid containing heparin sodium 12500 units of normal saline 2L preflushing filter and pipeline was used before the beginning of hemofiltration, and the preflushing solution containing heparin sodium was discharged when the blood was drawn. Low molecular weight heparin group (group A): low molecular heparin loading of 40 IUU / kg, and then continuously pumped into the dose of 4 IU / kg / h. In the citrate group (group B), the initial sodium citrate pump velocity (ml/h) was set to 1.2-1.5 times of the velocity of blood flow. The velocity of calcium gluconate pump was 1.2-1.5 times that of the velocity of citric acid pump. The rate of calcium gluconate was adjusted according to the ion calcium behind the filter and the dosage of calcium gluconate was adjusted according to the ion calcium in vivo. The blood parameters, coagulation function, liver and kidney function and metabolism were monitored before and after CRRT treatment, and the efficacy and safety of anticoagulant were evaluated. Results: there were 33 patients in group B and 34 patients in group A in this study. There was no significant difference in age, weight, Apache 鈪，
本文编号：2128292
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