枸橼酸钠局部抗凝在危重症患者连续性肾脏替代治疗中的应用效果分析
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摘要
目的探讨枸橼酸钠局部抗凝在危重症患者连续性肾脏替代治疗中的应用效果。方法选取2015年11月至2018年2月在我院接受连续性肾脏替代治疗的危重症患者84例为研究对象,按照随机数字表法分为观察组和对照组,每组42例。对照组患者给予普通肝素进行抗凝,观察组患者给予4%枸橼酸钠局部抗凝。比较两组患者出血、凝血情况,治疗前后肾功能、电解质的变化情况以及不良反应发生情况。结果观察组患者的出血率(2.38%)明显低于对照组(19.05%),差异有统计学意义(P<0.05);两组患者的凝血率比较差异无统计学意义(P>0.05)。治疗24 h后,观察组患者的Ca~(2+)、HCO_3~-水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗后6个月,两组患者尿素氮(BUN)、血肌酐(Scr)水平均明显降低(P<0.05),但两组患者的BUN、Scr水平比较差异无统计学意义(P>0.05)。治疗期间,两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论在危重症患者连续性肾脏替代治疗中,枸橼酸钠局部抗凝效果显著,不影响患者肾功能,有利于维持患者电解质的稳定。
Objective To explore the application effect of sodium citrate local anticoagulation in continuous renal replacement therapy on critically ill patients. Methods A total of 84 critically ill patients who underwent continuous renal replacement therapy in our hospital from November 2015 to February 2018 were selected and randomly divided into observation group and control group, with 42 cases in each group. The control group received unfractionated heparin for anticoagulation, and the observation group received 4% sodium citrate for local anticoagulation. The bleeding and coagulation condition, the changes of renal function and electrolytes as well as the occurrence of adverse reactions between the two groups were compared. Results The bleeding rate of the observation group(2.38%) was significantly lower than that in the control group(19.05%), and the difference was statistically significant(P<0.05). There was no statistically significant difference in the coagulation rate between the two groups(P>0.05). After treatment for 24 hours, the levels of Ca~+ and HCO_3~- in the observation group were significantly lower than those in the control group, and the difference was statistically significant(P<0.05). Six months after treatment, the levels of urea nitrogen(BUN) and serum creatinine(Scr) in both groups were significantly decreased(P<0.05); however, there was no statistically significant difference in BUN and Scr levels between the two groups(P>0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups during the treatment period(P>0.05). Conclusion Application sodium citrate local anticoagulation to continuous renal replacement therapy on critically ill patients can obtain effective anticoagulation, which shows little side effect on the renal function, and is beneficial to maintain electrolyte stability of the patients.
Objective To explore the application effect of sodium citrate local anticoagulation in continuous renal replacement therapy on critically ill patients. Methods A total of 84 critically ill patients who underwent continuous renal replacement therapy in our hospital from November 2015 to February 2018 were selected and randomly divided into observation group and control group, with 42 cases in each group. The control group received unfractionated heparin for anticoagulation, and the observation group received 4% sodium citrate for local anticoagulation. The bleeding and coagulation condition, the changes of renal function and electrolytes as well as the occurrence of adverse reactions between the two groups were compared. Results The bleeding rate of the observation group(2.38%) was significantly lower than that in the control group(19.05%), and the difference was statistically significant(P<0.05). There was no statistically significant difference in the coagulation rate between the two groups(P>0.05). After treatment for 24 hours, the levels of Ca~+ and HCO_3~- in the observation group were significantly lower than those in the control group, and the difference was statistically significant(P<0.05). Six months after treatment, the levels of urea nitrogen(BUN) and serum creatinine(Scr) in both groups were significantly decreased(P<0.05); however, there was no statistically significant difference in BUN and Scr levels between the two groups(P>0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups during the treatment period(P>0.05). Conclusion Application sodium citrate local anticoagulation to continuous renal replacement therapy on critically ill patients can obtain effective anticoagulation, which shows little side effect on the renal function, and is beneficial to maintain electrolyte stability of the patients.
引文
[1] Fealy N,Aitken L,du Toit E,et al.Evaluation of urea and creatinine change during continuous renal replacement therapy:effect of blood flow rate[J].Crit Care Resusc,2018,20(1):41-47.
[2] 叶涛,余追.局部枸橼酸钠抗凝对连续性肾脏替代治疗患者补钙速率的影响[J].内科急危重症杂志,2016,22(2):125-126.
[3] 喻文,罗红敏.危重患者持续肾脏替代治疗过程中局部柠檬酸钠与局部肝素抗凝的比较:一项多中心随机对照临床研究[J].中华危重病急救医学,2016,28(3):284.
[4] 孙丹,张叶,常江,等.枸橼酸钠抗凝在危重烧伤患者连续性肾脏替代治疗中的应用与护理[J].实用临床护理学电子杂志,2017,2(43):86,88.
[5] 王春亭,陈曼,于凯江,等.重症医学:华东地区现状调查(2015年第三次ICU普查)[J].中华重症医学电子杂志,2016,2(1):43-49.
[6] 罗玉珍,吴秀玲,林玉珍,等.局部枸橼酸钠抗凝进行连续性肾脏替代治疗在 ICU 脓毒血症患者中的应用[J].护理实践与研究,2016,13(14):1-2.
[7] Jung SY,Kwon J,Park S,et al.Phosphate is a potential biomarker of disease severity and predicts adverse outcomes in acute kidney injury patients undergoing continuous renal replacement therapy[J].PLoS One,2018,13(2):191290-191291.
[8] 白科,刘成军,符跃强,等.改良局部枸橼酸抗凝在儿童连续性血液滤过中的应用[J].中华儿科杂志,2017,55(5):334-337.
[9] 梅程清,叶正龙,邹晖,等.低分子量肝素抗凝在连续性肾脏替代治疗中致腰大肌血肿一例报道及文献复习[J].临床合理用药杂志,2017,10(24):119-120.
[10] 谢伟武.CRRT在MODS急性肾损伤患者中应用的时机探讨[J].内科,2017,12(1):97-99.
[11] 唐无忌,徐航,葛卫红.枸橼酸钠在连续型肾脏替代治疗中的应用[J].中国药师,2014,17(7):1231-1234.
[12] 王旭东,张超,黄广苏,等.局部枸橼酸钠抗凝在连续肾脏替代治疗老年高危出血患者中的疗效[J].中国老年学杂志,2015,35(19):5592-5593.
[13] 林玉珍,林银花,张丽珊,等.ICU脓毒血症患者接受连续肾脏替代治疗中抗凝剂使用后凝血功能的变化及护理[J].岭南现代临床外科,2016,16(2):242-245.
[14] 何圆凤.高危出血患者行局部枸橼酸抗凝血液净化的临床效果观察[J].医学信息,2016,29(25):139.
[15] 赵婧婷,廖常彬,余洪烈.局部枸橼酸抗凝在重症患者连续性肾脏替代治疗中的应用[J].临床肾脏病杂志,2014,14(7):402-405.
[16] 宁琪琪,孟庆华,朱跃科.局部枸橼酸抗凝在肝衰竭患者进行持续肾脏替代治疗中的应用进展[J].中华肝脏病杂志,2018,26(7):549-552.
[17] 吴青,陈新,周小华,等.不同抗凝方式对急性肾损伤患者持续性肾脏替代治疗的疗效比较[J].中国药业,2018,27(1):64-66.
[18] 张春,林婷,张靖垚,等.局部枸橼酸抗凝在肝切除术后急性肾损伤连续性肾脏替代治疗中临床疗效评价[J].中华危重病急救医学,2018,30(8):777-782.
[2] 叶涛,余追.局部枸橼酸钠抗凝对连续性肾脏替代治疗患者补钙速率的影响[J].内科急危重症杂志,2016,22(2):125-126.
[3] 喻文,罗红敏.危重患者持续肾脏替代治疗过程中局部柠檬酸钠与局部肝素抗凝的比较:一项多中心随机对照临床研究[J].中华危重病急救医学,2016,28(3):284.
[4] 孙丹,张叶,常江,等.枸橼酸钠抗凝在危重烧伤患者连续性肾脏替代治疗中的应用与护理[J].实用临床护理学电子杂志,2017,2(43):86,88.
[5] 王春亭,陈曼,于凯江,等.重症医学:华东地区现状调查(2015年第三次ICU普查)[J].中华重症医学电子杂志,2016,2(1):43-49.
[6] 罗玉珍,吴秀玲,林玉珍,等.局部枸橼酸钠抗凝进行连续性肾脏替代治疗在 ICU 脓毒血症患者中的应用[J].护理实践与研究,2016,13(14):1-2.
[7] Jung SY,Kwon J,Park S,et al.Phosphate is a potential biomarker of disease severity and predicts adverse outcomes in acute kidney injury patients undergoing continuous renal replacement therapy[J].PLoS One,2018,13(2):191290-191291.
[8] 白科,刘成军,符跃强,等.改良局部枸橼酸抗凝在儿童连续性血液滤过中的应用[J].中华儿科杂志,2017,55(5):334-337.
[9] 梅程清,叶正龙,邹晖,等.低分子量肝素抗凝在连续性肾脏替代治疗中致腰大肌血肿一例报道及文献复习[J].临床合理用药杂志,2017,10(24):119-120.
[10] 谢伟武.CRRT在MODS急性肾损伤患者中应用的时机探讨[J].内科,2017,12(1):97-99.
[11] 唐无忌,徐航,葛卫红.枸橼酸钠在连续型肾脏替代治疗中的应用[J].中国药师,2014,17(7):1231-1234.
[12] 王旭东,张超,黄广苏,等.局部枸橼酸钠抗凝在连续肾脏替代治疗老年高危出血患者中的疗效[J].中国老年学杂志,2015,35(19):5592-5593.
[13] 林玉珍,林银花,张丽珊,等.ICU脓毒血症患者接受连续肾脏替代治疗中抗凝剂使用后凝血功能的变化及护理[J].岭南现代临床外科,2016,16(2):242-245.
[14] 何圆凤.高危出血患者行局部枸橼酸抗凝血液净化的临床效果观察[J].医学信息,2016,29(25):139.
[15] 赵婧婷,廖常彬,余洪烈.局部枸橼酸抗凝在重症患者连续性肾脏替代治疗中的应用[J].临床肾脏病杂志,2014,14(7):402-405.
[16] 宁琪琪,孟庆华,朱跃科.局部枸橼酸抗凝在肝衰竭患者进行持续肾脏替代治疗中的应用进展[J].中华肝脏病杂志,2018,26(7):549-552.
[17] 吴青,陈新,周小华,等.不同抗凝方式对急性肾损伤患者持续性肾脏替代治疗的疗效比较[J].中国药业,2018,27(1):64-66.
[18] 张春,林婷,张靖垚,等.局部枸橼酸抗凝在肝切除术后急性肾损伤连续性肾脏替代治疗中临床疗效评价[J].中华危重病急救医学,2018,30(8):777-782.