摘要
目的观察局部枸橼酸体外抗凝(RCA)、低分子量肝素(LMWH)和无肝素抗凝方法在高危出血倾向患者进行血液透析的疗效和安全性。方法将行血液透析伴高危出血倾向的134例患者随机分成3组,A组采用RCA透析,B组采用无肝素透析,C组采用LMWH透析。观察3组患者出血、体外循环凝血、透析充分性和血气、电解质变化。结果①A组透析69例次,均顺利完成,未观察到出血或原有出血加剧;B组透析67例次,未观察到出血或原有出血加剧,其中6例次因透析中出现体外循环Ⅲ级凝血终止透析;C组透析65例次,发生7例次出血或原有出血加剧,6例次退出。②A组透析充分性(KT/V)明显高于B组(P<0.01),与C组的差异无统计学意义(P>0.05)。③A组透析后的血Ca^(2+)较透析前显著降低(P<0.05);HCO_3^-显著升高(P<0.01),但在正常范围;而透析前、后的血Na^+、pH值的差异均无统计学意义(P值均>0.05)。B、C两组透析前、后的血Ca^(2+)、总钙、Na^+、pH值及HCO_3^-的差异均无统计学意义(P值均>0.05)。结论RCA应用于高危出血倾向血液透析患者安全、有效。无肝素透析体外抗凝效果欠佳,影响透析顺利进行。对高危出血倾向血液透析患者采用LMWH透析仍需谨慎,有一定出血风险。
Objective To evaluate the efficacy and safety of hemodialysis with regional citrate anticoagulation （RCA）, low molecular-weight heparin（LMWH）, and heparin-free hemodialysis in patients at high risk of bleeding. Methods Totally 134 patients on hemodialysis were randomized into 3 groups according to the anticoagulation protocols, namely group A with 69 sessions using 30% RCA, group B with 67 sessions of heparin-free hemodialysis, and group C with 65 sessions using LMWH as the anticoagulant. The incidence of bleeding, extracorporeal coagulation, dialytic efficacy, and blood gas and electrolyte changes were recorded after the sessions. Results All patients in groups A completed the dialysis sessions uneventfully without occurrence of bleeding. In group B, 6 sessions were terminated due to Ⅲ degree extracorporeal coagulation. Bleeding or aggravation of the preexisting hemorrhagic condition occurred in 7 patients in group C, and 6 of them withdrew. KT/V in group A was significantly higher than that in group B （P 〈 0.01）, but similar to that in group C （P 〉 0.05） . A significant reduction in serum Ca^2＋ was noted after dialysis in group A （P 〈 0.05） accompanied by a marked increase in serum HCO3^- level （but within the normal range, P〈0.01） . The serum levels of Ca^2＋ , Ca, Na^＋ , pH and HCO3^- remained stable in groups B and C （P 〉 0.05） . Conclusion RCA is a safer and more effective option for hemodialysis in patients at high risk of bleeding. Heparin-free hemodialysis may cause extracorporeal coagulation, and LMWH should be used with caution in these patients for the potential risk of bleeding. （Shanghai Med J, 2007, 301898-901）
出处
《上海医学》
CAS
CSCD
北大核心
2007年第12期898-901,共4页
Shanghai Medical Journal
关键词
血液透析
出血
抗凝
枸橼酸
Hemodialysis
Bleeding
Anticoagulation
Citrate
