连续肾脏替代疗法中应用枸橼酸钠抗凝后发生代谢性酸中毒的危险因素分析

发布时间：2018-01-19 15:30

本文关键词： 连续肾脏替代疗法枸橼酸钠代谢性酸中毒危险因素　出处：《山东医药》2017年02期 　论文类型：期刊论文

【摘要】：目的分析连续肾脏替代疗法(CRRT)中应用枸橼酸钠抗凝后发生代谢性酸中毒的危险因素。方法回顾性分析接受CRRT治疗并使用枸橼酸钠抗凝的109例患者的临床资料,抗凝后发生代谢性酸中毒27例、未发生82例。观察两者有无吸烟、饮酒、冠心病、心律失常、慢性阻塞性肺疾病、哮喘、肺炎、肝炎、肝硬化、糖尿病、肠切除吻合术、水杨酸类药物使用、异烟肼类药物使用、双胍类药物使用,比较两者基础代谢率、收缩压、舒张压、心率、Pa O2、Pa CO2、FEV1/FVC%、乳酸、血糖、血酮、血胰岛素、血皮质醇、谷草转氨酶、谷丙转氨酶、乳酸脱氢酶、磷酸肌酸激酶同工酶、内生肌酐清除率、血浆肌酐、血尿素氮、尿量、血钾、血钙水平。采用Logistic多因素回归分析筛选出影响CRRT患者使用枸橼酸钠后发生代谢性酸中毒的危险因素。结果单因素分析结果显示,与未发生代谢性酸中毒患者相比,发生代谢性酸中毒患者吸烟、饮酒、慢性阻塞性肺疾病、肺炎、肝硬化、糖尿病、肠切除吻合术后、水杨酸类药物使用、异烟肼类药物使用、双胍类药物使用例数多,基础代谢率、Pa CO2、乳酸、血糖、血酮、血皮质醇、内生肌酐清除率、血清肌酐、尿素氮和血钾水平升高,Pa O2、FEV1/FVC%、血胰岛素、乳酸脱氢酶、尿量和血钙水平降低(P均0.05)。多元Logistic回归分析结果显示,低Pa O2、高Pa CO2、高乳酸、高血糖、高血酮、高血钾、高血浆肌酐、高血尿素氮、有肝硬化、有糖尿病、肠切除吻合术后均是CRRT患者枸橼酸钠抗凝后代谢性酸中毒发生的危险因素(P均0.05)。结论 CRRT中枸橼酸钠抗凝后发生代谢性酸中毒的危险因素有低Pa O2、高Pa CO2、高乳酸、高血糖、高血酮、高血钾、高血浆肌酐、高血尿素氮、肝硬化、糖尿病、肠切除吻合术。
[Abstract]:Objective to analyze continuous renal replacement therapy (CRRT). Methods the clinical data of 109 patients treated with CRRT and treated with sodium citrate anticoagulant were analyzed retrospectively. 27 cases of metabolic acidosis occurred after anticoagulation, 82 cases were not. Smoking, drinking, coronary heart disease, arrhythmia, chronic obstructive pulmonary disease, asthma, pneumonia, hepatitis, liver cirrhosis, diabetes mellitus were observed. Intestinal resection and anastomosis, salicylic acid, isoniazid and biguanidine were used to compare the basal metabolic rate, systolic blood pressure, diastolic blood pressure and heart rate of PaO2 CO2. FEV1 / FVC5, lactate, glucose, blood ketone, blood insulin, serum cortisol, glutamic oxalacetic transaminase, alanine aminotransferase, lactate dehydrogenase, creatine phosphokinase isoenzyme, endogenous creatinine clearance, plasma creatinine. Blood urea nitrogen, urine volume, blood potassium. Serum calcium level. The risk factors of metabolic acidosis after sodium citrate use in CRRT patients were screened by Logistic multivariate regression analysis. Compared with no metabolic acidosis patients, metabolic acidosis patients smoking, drinking, chronic obstructive pulmonary disease, pneumonia, liver cirrhosis, diabetes, intestinal resection and anastomosis, salicylic acid drugs use. There were many cases of isoniazid and biguanidine. The basal metabolic rate was Pa CO _ 2, lactic acid, blood glucose, blood ketone, blood cortisol, endogenous creatinine clearance rate, serum creatinine. The levels of urea nitrogen and serum potassium were increased, the FEV1 / FVC5 of PaO2 was increased, the blood insulin and lactate dehydrogenase were increased. The results of multivariate Logistic regression analysis showed that low Pa O 2, high Pa CO 2, high lactic acid, high blood glucose, high blood ketone, high blood potassium. High plasma creatinine, high blood urea nitrogen, cirrhosis, diabetes. The risk factors of metabolic acidosis after intestinal resection and anastomosis in patients with CRRT were 0.05). Conclusion the risk factor of metabolic acidosis after anticoagulation of sodium citrate in CRRT is low PaO2. High Pa CO 2, high lactic acid, high blood sugar, high blood ketone, high blood potassium, high plasma creatinine, high blood urea nitrogen, cirrhosis, diabetes, intestinal resection and anastomosis.
【作者单位】：川北医学院附属医院;
【分类号】：R459.5
【正文快照】： 连续肾脏替代疗法(CRRT)是目前临床上治疗急、慢性肾功能衰竭的有效疗法和抢救危重患者的重要器官支持手段。CRRT治疗过程中易形成血栓,导致血液中的毒素不能充分去除,故需要使用抗凝剂如枸橼酸钠,保证CRRT的成功实施[1]。接受CRRT治疗的危重患者病情复杂,存在高危或活动性出

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