局部枸橼酸抗凝在中毒患者血液灌流中的应用

发布时间：2019-03-16 16:09

【摘要】：目的:将局部枸橼酸抗凝技术(RCA,regional citrate anticoagulation)应用于中毒患者血液灌流(HP,hemoperfusion)治疗中,观察其临床使用效果。对RCA在中毒患者HP治疗中的应用价值进行探讨。方法:以就诊于青海省人民医院急诊ICU行HP治疗的60例中毒患者为研究对象。按随机数字法将患者分为观察组和对照组,观察组给予枸橼酸抗凝,对照组给予低分子肝素(LMWH,low moclecular weight heparin)抗凝,每例患者入院后行3次HP治疗。观察两组患者在HP治疗过程中出血并发症、滤器凝血发生情况,记录治疗前后患者ALT、CREA、CRP、HB、PLT、APTT、Lac、PH、HCO3-、Na~+、Ca~(2+)、iCa~(2+)的变化情况。两组间分组主效应比较使用重复测量方差分析,组内时间因素单独效应比较使用单因素方差分析进行比较,各治疗时间点组间比较应用t检验。结果:两组间ALT、CREA、Lac、HB、PLT、Na~+、Ca~(2+)、iCa~(2+)以及滤器凝血发生情况统计结果均无显著差异(P0.05),两组间APTT、CRP、PH、HCO3-以及出血并发症发生情况统计结果有显著差异(P0.05)。结论:1、RCA应用于中毒患者行HP治疗是安全、有效的,在密切监测情况下,无不良反应,值得临床推广;2、RCA抗凝效果好,并且可减少患者出血并发症的发生率;3、中毒患者行HP治疗时,RCA可能具有减轻患者体内炎症反应发展的作用。
[Abstract]:Aim: to observe the clinical effect of local citrate anticoagulation (RCA,regional citrate anticoagulation) in hemoperfusion (HP,hemoperfusion) of poisoned patients. To discuss the application value of RCA in HP treatment of poisoning patients. Methods: 60 cases of acute ICU poisoning treated by HP in Qinghai Provincial people's Hospital were studied. The patients were divided into observation group and control group according to random number method. The observation group was given citrate anticoagulation and the control group was treated with low molecular weight heparin (LMWH,low moclecular weight heparin). Each patient was treated with HP three times after admission. The changes of ALT,CREA,CRP,HB,PLT,APTT,Lac,PH,HCO3-,Na~, Ca~ (2) and iCa~ (2) were recorded before and after treatment. The bleeding complications and the occurrence of coagulation by filter were observed in the two groups of patients during the treatment of HP. The main effects of the two groups were compared by repeated measurement of variance, single factor ANOVA was used to compare the individual effects of time factors in the group, and t test was used to compare the treatment time points between the two groups. Results: there was no significant difference in ALT,CREA,Lac,HB,PLT,Na~, Ca~ (2), iCa~ (2) and filter coagulation between the two groups (P0.05). There was no significant difference in APTT,CRP,PH, between the two groups (P0.05). There were significant differences in HCO3- and bleeding complications (P0.05). Conclusion: 1, HP is safe and effective in the treatment of poisoning patients, and there are no adverse reactions under close monitoring, so it is worth popularizing in clinic. 2, the anticoagulation effect of RCA is good, and it can reduce the incidence of bleeding complications in patients. 3. When patients with poisoning were treated with HP, RCA might have the effect of alleviating the development of inflammatory reaction in patients.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R595

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