陈科署 林俊英 陈加链 蔡文阳

[摘要] 目的 分析比較连续性肾脏替代治疗（CRRT）脓毒症急性肾损伤病例过程中实施局部枸橼酸抗凝与全身肝素化抗凝的临床效果。方法 回顾性分析该院2016年1月—2018年12月诊治的60例脓毒症急性肾损伤患者CRRT治疗过程中完整的临床资料，对照组病例在CRRT治疗期间采用的抗凝方法为全身肝素化抗凝，观察组患者是应用枸橼酸抗凝，病例数各为30例。比较两组病例治疗后凝血功能、肾功能及滤器使用寿命。结果 两组病例的APTT和PT均升高，但对照组APTT（62.32±9.62）s、PT（22.84±1.12）s较观察组上升程度大，差异有统计学意义（t=5.184、8.056，P<0.05）;两组病例的PLT均有一定程度降低，但对照组（95.84±11.12）×109/L较观察组下降程度大，差异有统计学意义（t=12.055，P<0.05）;通过治疗，两组患者BUN和Scr水平值均降低，并且观察组降低水平治疗后BUN（11.58±2.57）μmol/L、Scr（212.23±51.97）μmol/L比对照组BUN（15.32±2.62）μmol/L、Scr（253.84±55.12）μmol/L明显，差异有统计学意义（t=5.182、9.359，P<0.05）。结论 应用枸橼酸抗凝在脓毒症急性肾损伤病例CRRT治疗时的临床疗效优于全身肝素化抗凝效果，有助于患者肾功能的改善和滤器使用时间的延长。

[关键词] 急性肾损伤;CRRT;枸橼酸;全身肝素化抗凝

[中图分类号] R692          [文献标识码] A          [文章编号] 1674-0742（2019）11（a）-0070-03

Comparative Analysis of the Effects of Citrate Anticoagulation and Systemic Heparinized Anticoagulation in Patients with Acute Renal Injury with Sepsis

CHEN Ke-shu， LIN Jun-ying， CHEN Jia-lian， CAI Wen-yang

Department of Critical Care Medicine， Chaozhou Central Hospital， Chaozhou， Guangdong Province， 521000 China

[Abstract] Objective To analyze the clinical effects of local citrate anticoagulation and systemic heparinized anticoagulation during continuous renal replacement therapy （CRRT） sepsis. Methods A retrospective analysis of the complete clinical data of 60 patients with acute renal injury with sepsis diagnosed in the hospital from January 2016 to December 2018， and anticoagulation during the treatment of CRRT in the control group. The method was systemic heparinized anticoagulation. The patients in the observation group were treated with citrate anticoagulation， and the number of cases was 30 cases. Coagulation function， renal function and filter life were compared between the two groups. Results The APTT and PT were increased in both groups， but the APTT （62.32±9.62） s and PT （22.84±1.12） s in the control group were significantly higher than those in the observation group， and the differences were statistically significant （t=5.184， 8.056， P<0.05）; PLT of both groups decreased to some extent， but the control group （95.84±11.12）×109/L was significantly lower than the observation group， and the difference was statistically significant （t=12.055， P<0.05）. After treatment， the BUN and Scr levels of the two groups were decreased， and the BUN （11.58±2.57）μmol/L， Scr（212.23±51.97）μmol/L， and the control group of BUN （15.32±2.62）μmol/L， Scr （253.84±55.12）μmol/L were lower after the treatment， being significant （t=5.182， 9.359， P<0.05）. Conclusion The clinical efficacy of citrate anticoagulation in the treatment of acute renal injury with sepsis is superior to the systemic heparinized anticoagulant effect， which is helpful for the improvement of renal function and the prolongation of filter use time.

[Key words] Acute kidney injury; CRRT; Citrate; Systemic heparinized anticoagulation

脓毒症是由感染导致的全身性炎症反应综合征，可使机体循环功能和脏器功能障碍，且预后较差，患者发展为脓毒症急性肾损伤的概率为40%，最终大概70%的病例死亡[1]，严重危害患者生命健康，临床上主要以持续性肾脏代替治疗（continuous renal replacement therapy，CRRT）法治疗脓毒症急性肾损伤，清理炎性因子，遏制炎症反应。CRTT成功概率与抗凝具有密切相关性，采用全身肝素化抗凝时出血和血小板减少症的发生风险也将增加;然而，局部枸橼酸抗凝（regional citrate anticoagulation，RCA）具有协同抗炎和抗氧化的作用，机体凝血功能不会受到抑制，而且粘附因子和补体激活的表达功能将被扼制[2]。该次方便选取2016年1月—2018年12月收治的60例患者为研究对象，对脓毒症急性肾损伤病例CRRT治疗中采用局部枸橼酸抗凝和全身肝素化抗凝的临床效果进行分析，报道如下。……