冉群英

DOI：10.16662/j.cnki.1674-0742.2017.20.113

[摘要] 目的 探讨低分子肝素与局部枸橼酸抗凝方案用于危重症患者连续性肾脏替代治疗效果差异。方法 研究对象随机选取该院2015年1月—2016年12月收治行连续性肾脏替代治疗治疗危重症患者共100例，以随机数字表法分为对照组（50例）和观察组（50例），分别行低分子肝素与局部枸橼酸抗凝；比较两组患者抗凝有效性、治疗前后凝血功能指标及出血事件发生率等。 结果 对照组抗凝有效0级、I级、II级及III级比例分别为32.00%，44.00%，16.00%，4.00%；观察组抗凝有效0级、I级、II级及III级比例分别为54.00%，40.00%，6.00%，0.00%；观察组患者抗凝有效性明显优于对照组（P<0.05）；观察组患者治疗后APTT水平均明显高于对照组、治疗前（P<0.05）；但两组患者治疗后PLT水平比较差异无统计学意义（P>0.05）；同时两组患者出血事件发生率比较差异无统计学意义（P>0.05）。结论 相较于低分子肝素，局部枸橼酸抗凝方案用于危重症患者连续性肾脏替代治疗可显著改善抗凝效果，延长APTT时间，且未导致出血事件发生风险上升。

[关键词] 连续性肾脏替代治疗；低分子肝素；枸橼酸；危重症

[中图分类号] R459 [文献标识码] A [文章编号] 1674-0742（2017）07（b）-0113-03

Comparative Analysis of Different Anticoagulant Methods in the Replacement Therapy of Continuous Kidney of Critically Ill Patients

RAN Qun-ying

ICU， Xiushan Peoples Hospital， Chongqing， 409900 China

[Abstract] Objective To discuss the difference in the effect of low molecular heparin and local citric acid anticoagulant plan in the replacement therapy of continuous kidney of critically ill patients. Methods 100 cases of critically ill patients with continuous kidney therapy admitted and treated in our hospital from January 2015 to December 2016 were selected and randomly divided into two groups with 50 cases in each， respectively treated with low molecular heparin and local citric acid anticoagulant plan， and the effectiveness， anticoagulant function indexes before and after treatment and incidence rate of bleeding events were compared between the two groups. Results The ratios of effective 0 level， I level， II level and III level in the observation group were better than those in the control group（32.00%，44.00%，16.00%，4.00% vs 54.00%，40.00%，6.00%，0.00%）（P<0.05）， after treatment， the APTT level in the observation group was obviously higher than that in the control group and that before treatment（P<0.05）， but the difference in the PLT level between the two groups was not obvious（P>0.05）， at the same time， the difference in the incidence rate of bleeding events between the two groups was not obvious（P>0.05）. Conclusion The local citric acid anticoagulant plan in the critically ill patients with continuous kidney can obviously improve the anticoagulant effect， prolong the APTT time and does not cause the increase of occurrence risks.

[Key words] Replacement therapy of continuous kidney of critically ill patients； Low molecular heparin； Citric acid； Critically ill

CRRT是危重癥患者临床治疗首选方案之一，大量研究显示，其治疗过程中如未行充分有效抗凝处理，常可导致超滤率持续下降和血滤器使用寿命下降，在严重影响治疗效果的同时加重患者负担[1]。目前CRRT治疗中常用抗凝剂以低分子肝素和枸橼酸钠为主[2]，但何者可使患者获得更佳临床收益尚无明确定论。该次研究以该院2015年1月—2016年12月收治行连续性肾脏替代治疗治疗危重症患者共100例作为研究对象，分别给予低分子肝素与局部枸橼酸抗凝，探讨不同抗凝方法用于危重症患者连续性肾脏替代治疗效果差异，现报道如下。en……