内科理论与实践2023，Vol.18Issue(5)：322-327,6.DOI:10.16138/j.1673-6087.2023.05.003
普通含钙透析液分段枸橼酸抗凝与无肝素透析在高危出血透析患者中的应用
Comparison of ordinary calcium-containing dialysate segmented regional citrate anticoagulation hemodialysis and heparin-free hemodialysis in patients with high risk of bleeding
摘要
Abstract
Objective To investigate the safety and efficacy of regional citrate anticoagulation(RCA)with ordinary calcium-containing dialysate in hemodialysis,and compare its differences in coagulation status and treatment time with heparin-free hemodialysis in high-risk bleeding patients.Methods Maintenance hemodialysis patients with high risk of bleeding from Dalian Municipal Central Hospital from January in 2019 to December in 2021 were selected,a total of 35 patients were enrolled(19 males and 16 females),and they received heparin-free hemodialysis or 4%sodium regional cit-rate anticoagulation treated hemodialysis.Citrate was infused into the arterial line and vein line through the dialyzer.The electrolyte,blood pressure,and coagulation system in hemodialysis patient were compared before and after the application of segmented citrate anticoagulation.The differences of coagulation and treatment time between the two methods were compared.Results In the citrate treated group,through adjusting the parameters of the dialysis machine online,the serum sodium could be kept stable after dialysis(P＞0.05).Hypocalcemia didn't occur in the application of calcium-containing dialysate(1.5 mmol/L),while serum calcium increased after dialysis(P<0.05).The blood pressure and heart rate of the pa-tients in the citrate treated group were stable before and after dialysis(P＞0.05).Activated partial thromboplastin time(APTT)of patients after local citrate anticoagulation was prolonged compared with that before dialysis(P<0.05),and the remaining coagulation time was not significantly different from that before dialysis(P＞0.05).In the citrate treated group,the anticoagulation efficacy of the dialyzer and venous pot(P<0.05),ultrafiltration volume(P<0.05)and urea clearance in-dex(Kt/V)(P<0.001)were significantly higher than those in the non-heparin group,while the actual dialysis time was longer than that in the non-heparin group(P<0.001).Conclusions The segmented regional citrate anticoagulation of ordinary cal-cium-containing dialysate is safe and effective in high-risk bleeding risk dialysis patients,and its anticoagulant effect is better than that in heparin-free hemodialysis.关键词
局部枸橼酸抗凝/无肝素透析/含钙透析液/终末期肾病Key words
Regional citrate anticoagulation/Heparin-free hemodialysis/Calcium-containing dialysate/End-stage renal disease分类
医药卫生引用本文复制引用
张瑜,王志宏,董毳,郐婷婷,由莲莲,刘书馨..普通含钙透析液分段枸橼酸抗凝与无肝素透析在高危出血透析患者中的应用[J].内科理论与实践,2023,18(5):322-327,6.基金项目
大连市医学重点专科"登峰计划"项目(项目编号:2022ZZ232、2022ZZ247) （项目编号:2022ZZ232、2022ZZ247）
