局部枸橼酸抗凝与全身肝素化抗凝在脓毒症急性肾损伤患者CRRT的疗效观察

摘要

目的 探讨局部枸橼酸抗凝与全身肝素抗凝分别应用于脓毒症急性肾损伤患者连续性肾脏替代(CRRT)治疗中的效果.方法 选取2015年1月～2016年6月我院收治的脓毒症急性肾损伤患者88例为研究对象,随机分为观察组与对照组,每组各44例,两组患者均行CRRT治疗,观察组患者在治疗过程中进行局部枸橼酸抗凝,对照组患者在治疗过程中进行全身肝素抗凝,对比两组患者治疗前后肾功能、凝血相关指标、碳酸氢根离子(HCO3)浓度变化情况,并对比两组患者滤器使用寿命.结果 治疗后,两组患者的Scr、BUN水平均较治疗前降低,且观察组患者的Scr、BUN水平低于对照组(P＜0.05);两组患者的APTT、PT较治疗前升高,PLT较治疗前降低,但观察组患者的APTT、PT显著低于对照组,PLT显著高于对照组(P＜0.05);两组患者治疗前后HCO3-浓度对比差异均无统计学意义(P＞0.05),但与对照组对比,观察组患者的滤器使用寿命显著延长(P＜0.05).结论 在脓毒性急性肾损伤患者CRRT治疗中,应用局部枸橼酸抗凝,较全身肝素的抗凝效果更佳,且能显著改善患者肾功能,延长滤器使用寿命.%Objective To investigate the effect of local citrate anticoagulation and systemic heparin anticoagulation on the treatment of continuous renal replacement therapy (CRRT) in patients with acute renal injury of sepsis.Methods 88 patients with sepsis acute renal injury admitted in our hospital from January 2015 to June 2016 were randomly divided into observation group and control group.CRRT treatment was performed in both groups.In the treatment group,(HCO3) in the control group was compared with that of the control group (P＜0.05).The levels of renal function,coagulation-related index and bicarbonate ion (HCO3-) in the control group were significantly higher than those in the control group Comparison of the two groups of patients with filter life.Results After treatment,the Scr and BUN levels of both groups were lower than those before treatment,and the Scr and BUN levels of the patients after treatment were lower than those in the control group (P＜0.05).APTT and PT after treatment of the two groups were increased.PLT before the treatment reduced.APTT and PT of observation group after treatment were significantly lower than that of control group after treatment.PLT of observation group was significantly higher than control group after treatment (P＜0.05).There was no significant difference of HCO3-concentration between the observation group and the control group before and after treatment (P＜0.05).Compared with that of the control group,the life expectancy of the filter in the observation group was significantly prolonged (P＜0.05).Conclusion In the treatment of CRRT,local anticoagulation with citric acid is more effective than systemic heparin anticoagulation in patients with septic acute kidney injury,and which can significantly improve the renal function and prolong the life of the filter.