李康峰, 汤小芳, 陈欢, 徐佩佩, 石林, 韦旭, 徐容, 张玉强. 4%枸橼酸钠运用于不同持续性血液净化模式的抗凝分析[J]. 临床肾脏病杂志, 2023, 23(2): 119-123. DOI: 10.3969/j.issn.1671-2390.2023.02.006
    引用本文: 李康峰, 汤小芳, 陈欢, 徐佩佩, 石林, 韦旭, 徐容, 张玉强. 4%枸橼酸钠运用于不同持续性血液净化模式的抗凝分析[J]. 临床肾脏病杂志, 2023, 23(2): 119-123. DOI: 10.3969/j.issn.1671-2390.2023.02.006
    Li Kang-feng, Tang Xiao-fang, Chen Huan, Xu Pei-pei, Shi Lin, Wei Xu, Xu Rong, Zhang Yu-qiang. Anticoagulation of 4% sodium citrate for different modes of continuous blood purification[J]. Journal of Clinical Nephrology, 2023, 23(2): 119-123. DOI: 10.3969/j.issn.1671-2390.2023.02.006
    Citation: Li Kang-feng, Tang Xiao-fang, Chen Huan, Xu Pei-pei, Shi Lin, Wei Xu, Xu Rong, Zhang Yu-qiang. Anticoagulation of 4% sodium citrate for different modes of continuous blood purification[J]. Journal of Clinical Nephrology, 2023, 23(2): 119-123. DOI: 10.3969/j.issn.1671-2390.2023.02.006

    4%枸橼酸钠运用于不同持续性血液净化模式的抗凝分析

    Anticoagulation of 4% sodium citrate for different modes of continuous blood purification

    • 摘要: 目的 探究4%枸橼酸钠运用在不同持续性血液净化治疗的效果并进行比较分析。方法 回顾性分析45例终末期肾病患者具有出血倾向或活动性出血,均以4%枸橼酸钠体外抗凝,分为A组(22例)行持续性血液透析滤过方式及B组(23例)行连续性血液滤过模式。两组同用不含碱基置换液于持续性血液净化治疗24 h,A组、B组均由外周补充碱基。观察两组患者治疗前中后血肌酐、电解质、活化部分凝血活酶时间、血气以及滤器前钙离子等变化,同时观察两组滤器及管路凝血情况。结果 A、B两组均顺利完成24 h持续性血液净化治疗,两组均未发生碱中毒、高钠血症,未见使用枸橼酸钠产生的相关的低钙抽搐、口唇麻木等临床症状。两组治疗充分性均良好,治疗充分性达标,A组额外周补充碱基量显著高于B组。结论 在24 h连续性血液净化治疗中选用4%浓度枸橼酸钠是较安全有效的抗凝方式,持续性血液滤过模式的外周补碱量少、更接近于生理模式且血流动力学稳定,值得临床推广。

       

      Abstract: Objective To explore the effects of 4% sodium citrate for different modes of continuous blood purification(CBP).Methods Clinical data were retrospectively reviewed for 45 end-stage kidney disease patients with bleeding tendency or active bleeding.They were divided into two groups of A(n=22) and B(n=23).And all of them were anti-coagulated with 4% sodium citrate in vitro.Group A received continuous hemodiafiltration while group B had continuous hemofiltration.Both groups received base-free substitution fluid for 24 hours.Groups A and B were supplemented with peripheral base.The changes of blood creatinine, electrolyte, activated partial thromboplastin time(APTT), blood gas and calcium ion pre-filter were recorded before, during and after treatment.Coagulation status of filter and pipeline was observed.Results Both groups successfully completed 24-hour continuous blood purification.There was no onset of alkalosis, hypernatremia, hypocalcemic convulsion or lip numbness related to citrate anticoagulation.The adequacy of treatment was decent in both groups.And amount of base supplementation was significantly higher in group A than that in group B.Conclusions During 24-hour continuous blood purification, anticoagulation of 4% sodium citrate is both safe and efficacious.Less base supplement is required for continuous hemofiltration mode and it mimics closely the physiological mode.And continuous hemofiltration is worthy of a wider popularization.

       

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