枸橼酸钠对比低分子肝素抗凝在持续肾脏替代治疗中的应用

摘要

Objective To compare the application of sodium citrate and heparin in the treatment of CRRT through a retrospective analysis .Methods A total of 53 patients were randomly divided into two groups , patients in the two groups were treated with sodium citrate and low molecular weight heparin for CRRT pre -wash. We comparred the coagulation ,electrolyte, acid-base balance and the life of the filter pipeline of the two groups . Results The life of filter of citrate hemodialysis group was significantly longer than low molecular weight heparin group.The differences of APTT and TT between the two groups was statistically significant (P<0.05).Sodium citrate was precede heparin in anticoagulant effect for it's stable electrolyte and acid -base balance .Conclusions Anticoagulation of sodium citrate is safe and effective , suitable for promotion .Closely observe during dialysis and adjust the dose of sodium citrate according to arterial blood gas and electrolyte can ensure the successful treatment.%目的：通过回顾性分析比较枸橼酸钠与肝素抗凝在CRRT 治疗中的应用。方法纳入54例患者，随机分为两组，分别接受枸橼酸钠，低分子肝素预冲CRRT，同步抗凝，比较凝血指标、电解质和酸碱平衡以及滤器管路寿命。结果枸橼酸盐组血液透析器使用时间明显长于低分子肝素组。枸橼酸盐组在血液透析中APTT、PT与低分子肝素组比较，差异均有统计学意义（ P＜0．05），应用枸橼酸钠局部抗凝后血滤管道内血液的凝血指标（APTT、PT）延长，经过滤器后凝血指标变化不大（P＞0．05），体内静脉血凝血指标恢复正常范围内；低分子肝素组滤器前后管道中凝血指标变化不大（P＞0．05），与枸橼酸钠组比较，低分子肝素组在体内的（ APTT、PT）均延长。结论枸橼酸钠抗凝方式安全有效，适于推广。在透析过程中密切观察，依据动脉血气，电解质结果调整枸橼酸钠剂量，使每次血液滤过治疗顺利有效地进行，是治疗成功的保障。