邵汉权　杨雪　邓勇进

【摘要】 目的：研究枸櫞酸抗凝在肾衰竭合并脑出血患者血液滤过治疗中的安全性及有效性。方法：选择2015年1月-2017年12月本院ICU治疗的肾衰竭合并脑出血且行血液滤过患者40例进行回顾性分析，血液滤过治疗过程中分为枸橼酸抗凝（RCA）组与无抗凝组，每组20例。观察比较两组治疗前、治疗后24 h GCS评分、APACHE Ⅱ评分、血红蛋白、血小板、APTT、血肌酐、尿素氮的变化以及滤器寿命、病死率。结果：两组治疗后24 h APACHEⅡ评分、血肌酐、尿素氮均较治疗前好转（P<0.05），RCA组更优。RCA组治疗后24 h血红蛋白、血小板、APTT、GCS评分与治疗前比较，差异均无统计学意义（P>0.05）。无抗凝组治疗后24 h APTT与治疗前比较，差异无统计学意义（P>0.05）。治疗后24 h无抗凝组血小板下降较RCA组明显，差异有统计学意义（P<0.05）。无抗凝组的血红蛋白下降趋势较RCA组明显（F=14.06，P<0.05）。RCA组滤器平均使用寿命（7.9±0.5）h，长于无抗凝组（6.6±1.9）h，差异有统计学意义（t=2.885，P=0.006）。治疗14 d内，两组病死率比较，差异无统计学意义（字2=0.229，P=0.633）。结论：在血液滤过治疗肾衰竭合并脑出血患者中，采用枸橼酸抗凝相对安全有效。

【关键词】 枸橼酸抗凝； 肾衰竭； 脑出血； 血液滤过

Application Research of Citrate Anticoagulation to Hemofiltration in the Treatment of Patients with Renal Failure Combined with Cerebral Hemorrhage/SHAO Hanquan，YANG Xue，DENG Yongjin，et al.

//Medical Innovation of China，2018，15（14）：130-133

【Abstract】 Objective：To investigate the safety and efficacy of citrate anticoagulation to hemofiltration in the treatment of patients with renal failure combined with cerebral hemorrhage.Method：A total of 40 patients with renal failure combined with cerebral hemorrhage during hemofiltration in our hospital from January 2015 to December 2017 were divided into RCA group and no anticoagulant group，20 patients in each group.GCS score，Apache Ⅱ score，Hb，ALT，APTT，serum creatinine，blood urea nitrogen before treatment and 24 h after treatment，filter lifespan and mortality were compared between the two groups.Result：There were significant differences in levels of Apache Ⅱ score，serum creatinine，urea nitrogen at 24 h after treatment in the two groups（P<0.05），RCA group was better than those of no anticoagulant group（P<0.05）.There were no significant differences in levels of Hb，PLT，APTT，GCS score before treatment and 24 h after treatment in RCA group（P>0.05）.There was no significant difference in APTT between 24 h after treatment and before treatment in no anticoagulant group（P>0.05）.The decline degree of PLT at 24 h after treatment in the no anticoagulant group was more than that in RCA group（P<0.05）.The decreasing trend of hemoglobin in non-anticoagulant group was more obvious than that in RCA group（F=14.06，P<0.05）.The filter lifespan in RCA group was （7.9±0.5）h，which was significantly longer than （6.6±1.9）h in the no anticoagulant group，the difference was statistically significant（t=2.885，P=0.006）.There was no significant difference in 14 d mortality between the two groups（字2=0.229，P=0.633）.Conclusion：The clinical application of citrate anticoagulation to hemofiltration in the treatment of patients with renal failure combined with cerebral hemorrhage is safe and efficient.

【Key words】 Citrate anticoagulation； Renal failure； Cerebral hemorrhage； Hemofiltration

First-authors address：Dongguan Peoples Hospital，Dongguan 523059，China

doi：10.3969/j.issn.1674-4985.2018.14.032

肾衰竭是临床上常见的一种病症，由于肾功能衰竭，造成水、电解质紊乱以及酸碱失衡等，降低了患者的生存质量[1]，血液净化技术可以改善肾脏病患者的临床症状以及提高患者的生存质量[2]。肾衰竭患者由于长期接受血液透析治疗，经常引发不同的并发症。由于肾性高血压、血液透析相关性高血压、长期使用抗凝剂导致凝血功能异常、血管钙化导致出现缺损、营养不良等因素[3]，导致此类患者并发脑出血的风险增高，其死亡率也高[4]。当肾衰竭患者合并脑出血时，给治疗带来很大的困难，肾衰竭唯有肾脏替代治疗才可以延续生命，其中血液滤过治疗是目前治疗危重患者肾衰竭重要手段，有效的抗凝可以防止滤器凝血、延长治疗时间[5]。最常使用的肝素，因为……