简化枸橼酸抗凝无肝素透析的疗效观察

发布时间：2018-03-28 18:05

本文选题：维持性血液透析　切入点：凝血　出处：《肾脏病与透析肾移植杂志》2017年04期

【摘要】：目的:观察无肝素透析时采用简化枸橼酸抗凝(RCA)方案进行抗凝的有效性及安全性。方法:选择2016年6月~2017年1月在南京总医院国家肾脏疾病临床医学研究中心行维持性血液透析治疗、因各种原因需行无肝素透析患者共42例,采用简化RCA方案抗凝,前期患者采用方案一,后期患者采用方案二,两种方案都不另外补充钙剂。观察抗凝效果、单次透析持续时间及可能出现的不良反应。结果:13例患者采用方案一抗凝,共完成37例次透析,29例患者采用方案二抗凝,共完成129例次透析,所有治疗均未发生不良反应。完成预定3~4h透析治疗的比例:方案一为75.7%,方案二为98.4%(P0.01)。将滤器及静脉壶中度以下凝血视为抗凝有效,方案一及方案二的滤器抗凝有效率分别为89.12%、94.57%(P0.05),而静脉壶抗凝有效率分别为78.3%、90.7%(P0.05)。方案二患者监测透析前后血气,结果显示透析后离子钙水平与透析前无显著性差异(P0.05)。结论:简化RCA方案能保证多数患者无肝素透析治疗顺利进行,避免滤器、静脉壶严重凝血及其导致的透析提前中止,特别是方案二,静脉壶凝血的发生率明显下降,并且未发生明显不良反应,对血气结果无明显影响。
[Abstract]:Objective: to observe the efficacy and safety of simplified citrate anticoagulant (RCA) regimen in hemodialysis without heparin. Methods: from June 2016 to January 2017, we selected the National Renal Disease Clinical Medical Research Center of Nanjing General Hospital. Maintenance hemodialysis, A total of 42 patients with non-heparin dialysis were treated with simplified RCA regimen for various reasons. The patients were treated with regimen one in the early stage and the patients in the later stage with the second regimen. Neither regimen was supplemented with calcium separately. The anticoagulant effect was observed. Results Thirteen patients with single dialysis were treated with one anticoagulant, 29 patients with 37 hemodialysis patients were treated with the second anticoagulant, and 129 patients with hemodialysis. There were no adverse reactions in all the treatments. The proportion of hemodialysis therapy scheduled for 34 h was 75.7 for scheme one and 98.4 for P0.01 for scheme two. The coagulation of filter and venous jug was regarded as anticoagulant. The anticoagulant effective rates of the filters in the first and second schemes were 89.12 and 94.57, respectively, and the anticoagulant efficiency of the venous jugs were 78.3 and 90.7, respectively. The blood gas of the patients before and after dialysis was monitored. The results showed that there was no significant difference in ion calcium level after dialysis compared with that before dialysis. Conclusion: the simplified RCA regimen can ensure the successful treatment without heparin in most patients, and avoid the filter, venous coagulation and the early termination of dialysis. In the second scheme, the incidence of venous coagulation decreased significantly, and no significant adverse reactions occurred, which had no significant effect on the blood gas results.
【作者单位】：南京大学医学院附属金陵医院(南京总医院)肾脏科;南京大学医学院附属金陵医院(南京总医院)肾脏科国家肾脏疾病临床医学研究中心全军肾脏病研究所;
【基金】：国家自然科学基金面上项目(81170708) 国家重点研发计划课题(2016YFC0904103)
【分类号】：R692.5

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