简化枸橼酸抗凝方案用于无肝素透析的效果观察
发布时间：2018-08-01 12:00
【摘要】：目的:观察无肝素透析时采用简化枸橼酸抗凝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月在我科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人,采用简化方式进行枸橼酸抗凝:前期采用方案一进行抗凝,即使用15%枸橼酸三钠(TSC)在滤器前以40ml/h的速度持续输入;后期患者采用方案二进行抗凝,即在前者基础上同时在静脉壶以l0ml/h的速度输入15%TSC。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:简化枸橼酸抗凝方式能保证多数无肝素透析治疗的顺利进行,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 citric acid anticoagulant regimen in non-heparin dialysis. Methods: 42 patients were treated with maintenance hemodialysis in our department from June 2016 to January 2017. 42 patients were treated without heparin dialysis for various reasons. Even though 15% trisodium citrate (TSC) was continuously injected in front of the filter at the speed of 40ml/h, in the later stage the patients were treated with anticoagulant, that is, on the basis of the former, 15 TSCs were injected at the speed of l0ml/h at the same time in the jug of vein. Neither option is supplemented with calcium. To observe the anticoagulant effect, duration of single dialysis and possible adverse reactions. Results Thirteen patients were treated with one anticoagulant, a total of 37 patients with hemodialysis were treated with anticoagulant, 29 patients with hemodialysis were treated with the second anticoagulant, and 129 patients were dialyzed. No adverse reaction was found in all the treatments. The proportion of patients who completed the scheduled 3-4 h dialysis treatment was 75.775% in the first scheme and 98.4% (p0.01) in the second scheme. The anticoagulant efficiency of the filter and the blood below the middle of the jug was considered to be effective. The effective rate of the filter was 89.12% (P 0.05) and 90.7% (p0.05), respectively, and that of the venous jug was 90.7% (p0.05). The anticoagulant efficiency of the filter was 94.57% (P 0.05), and that of the venous jug was 78.3% (p0.05). The results of monitoring blood gas before and after dialysis showed that there was no significant difference in the level of ion calcium between before and after dialysis (p0.05). Conclusion: the simplified anticoagulant method of citric acid can ensure the smooth progress of most hemodialysis without heparin, and avoid the filter, the severe coagulation of the venous jug and the early termination of dialysis, especially in the second scheme, the incidence of coagulation in the venous pot is obviously decreased. There was no obvious adverse effect on blood gas.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5
，
本文编号：2157509
[Abstract]:Objective: to observe the efficacy and safety of simplified citric acid anticoagulant regimen in non-heparin dialysis. Methods: 42 patients were treated with maintenance hemodialysis in our department from June 2016 to January 2017. 42 patients were treated without heparin dialysis for various reasons. Even though 15% trisodium citrate (TSC) was continuously injected in front of the filter at the speed of 40ml/h, in the later stage the patients were treated with anticoagulant, that is, on the basis of the former, 15 TSCs were injected at the speed of l0ml/h at the same time in the jug of vein. Neither option is supplemented with calcium. To observe the anticoagulant effect, duration of single dialysis and possible adverse reactions. Results Thirteen patients were treated with one anticoagulant, a total of 37 patients with hemodialysis were treated with anticoagulant, 29 patients with hemodialysis were treated with the second anticoagulant, and 129 patients were dialyzed. No adverse reaction was found in all the treatments. The proportion of patients who completed the scheduled 3-4 h dialysis treatment was 75.775% in the first scheme and 98.4% (p0.01) in the second scheme. The anticoagulant efficiency of the filter and the blood below the middle of the jug was considered to be effective. The effective rate of the filter was 89.12% (P 0.05) and 90.7% (p0.05), respectively, and that of the venous jug was 90.7% (p0.05). The anticoagulant efficiency of the filter was 94.57% (P 0.05), and that of the venous jug was 78.3% (p0.05). The results of monitoring blood gas before and after dialysis showed that there was no significant difference in the level of ion calcium between before and after dialysis (p0.05). Conclusion: the simplified anticoagulant method of citric acid can ensure the smooth progress of most hemodialysis without heparin, and avoid the filter, the severe coagulation of the venous jug and the early termination of dialysis, especially in the second scheme, the incidence of coagulation in the venous pot is obviously decreased. There was no obvious adverse effect on blood gas.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5
，
本文编号：2157509
本文链接：https://www.wllwen.com/yixuelunwen/mjlw/2157509.html
最近更新
教材专著
