摘要
目的探讨枸橼酸盐两段式抗凝在含钙置换液连续性静脉-静脉血液滤过(CVVH)中的抗凝效果及安全性。方法将应用枸橼酸钠抗凝CVVH的79例患者随机分为两组。对照组:枸橼酸盐一段式抗凝39例,即4%枸橼酸钠溶液在滤器前以200 ml/h的速度持续泵入;试验组:枸橼酸盐两段式抗凝40例,即以180 ml/h速度在滤器前持续泵入4%枸橼酸钠溶液,同时在静脉壶泵入20 ml/h(滤器前与静脉壶处泵入的枸橼酸钠量比例9∶1)。两组均使用含钙置换液(钙离子为1.5 mmol/L),且不用在静脉回血端常规补充钙剂。观察两组滤器及静脉壶的凝血情况,根据凝血分级计算抗凝有效率。检测治疗前和治疗2 h、6 h和12 h血常规、凝血系列、血气分析、钙离子(Ca 2+)浓度。结果4%枸橼酸钠溶液输注总量在试验组为(200.42±5.85)ml/h,对照组为(202.05±8.33)ml/h,两组间比较差异无统计学意义(P=0.325)。抗凝有效率在静脉壶部位试验组明显高于对照组(P=0.026),在滤器部位两组差异无统计学意义(P=0.986)。试验组在CVVH治疗过程中2,6,12 h外周血及滤器后游离Ca 2+浓度与对照组相比差异无统计学意义。结论枸橼酸钠两段式抗凝与传统的一段式抗凝相比较,在含钙置换液连续性肾脏替代治疗中是安全的,且更为有效。
Objective To investigate the efficacy and safety of a two-stage regional citrate anticoagulation(RCA)in continuous veno-venous hemofiltration with calcium-containing replacement solution.Methods Seventy-nine patients treated with RCA-based predilution CVVH were randomly assigned to experiment group(two-stage citrate anticoagulation,n=40)and control group(one-stage citrate anticoagulation,n=39).In control group,the patients were only infused prefilter(200 ml/h)with 4%sodium citrate solution.In experiment group,the patients were infused with 4%sodium citrate solution both prefilter(180 ml/h)and at the venous drip chamber(20 ml/h).The ratio of sodium citrate volume between the pre-filter and the venous drip chamber was 9∶1 in experiment group.All patients in two groups were given calcium-containing replacement(ionized calcium 1.5 mmol/L),but not administered with calcium supplement routinely in venous circuit.Clinical parameters were monitored regularly before and during the treatment,including blood routine,coagulation,blood gas analysis,and blood ionized calcium levels(Ca 2+).Coagulation state at filter and venous drip chamber was observed during the treatment.The effective rate of anticoagulation was calculated according to the coagulation classification.Results The infusion volume of 4%sodium citrate solution for anticoagulation was(200.42±5.85)ml/h in experiment group and(202.05±8.33)ml/h in control group.There was no significant difference in the volume of sodium citrate for anticoagulation between the two groups(P=0.325).The effective rate of anticoagulation at the venous drip chamber was significantly higher in experiment group than in control group(P=0.026).There was no significant difference in the anticoagulation efficiency at the filter between the two groups(P=0.986).There was no significant difference in the concentration of ionized calcium in vivo and post-filter between experiment group and control group at 2 h,6 h and 12 h during CVVH treatment.Conclusion Two-stage citrate anticoagulation is superior to one-stage anticoagulation in the effective rate of anticoagulation,and is a safe anticoagulation option for continuous venovenous hemofiltration with calcium replacement solution.
作者
韩锦
王欣
李侠
赵莉
杨艳艳
郭蕊军
付荣国
王莉
HAN Jin;WANG Xin;LI Xia;ZHAO Li;YANG Yanyan;GUO Ruijun;FU Rongguo;WANG Li(Department of Nephrology,Se-cond Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China)
出处
《山西医科大学学报》
CAS
2019年第12期1750-1754,共5页
Journal of Shanxi Medical University
基金
国家自然科学基金资助项目(81570673)
陕西省重点研发计划项目(2017SF-033)
关键词
枸橼酸盐抗凝剂
含钙置换液
两段式抗凝
连续性静脉-静脉血液滤过治疗
citrate anticoagulant
calcium-containing replacement solution
two-stage citrate anticoagulation
continuous venovenous hemofiltration
