中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2014年
12期
953-956
,共4页
王婷立%张凌%陈志文%付平
王婷立%張凌%陳誌文%付平
왕정립%장릉%진지문%부평
持续缓慢低效血液透析%枸橼酸%肝素%抗凝%无钙透析液
持續緩慢低效血液透析%枸櫞痠%肝素%抗凝%無鈣透析液
지속완만저효혈액투석%구연산%간소%항응%무개투석액
Sustained low efficiency dialysis%Citrate%Heparin%Anticoagulation%Calcium-free dialysate
目的 通过对比持续缓慢低效血液透析(SLED)中局部枸橼酸抗凝与肝素抗凝的效果,为临床选择更优化的抗凝方式提供依据.方法 行SLED的63例急性肾损伤或终末期肾病患者,随机分为局部枸橼酸抗凝组和普通肝素抗凝组,均采用颈/股静脉留置双腔导管,费森尤斯公司生产的4008sARrTplus透析机和Polyflux 14L透析器,治疗时间8h,血流量150 ml/min.治疗前后测2组患者凝血酶原时间(PT)、APTT、PLT.结果 63例患者共行SLED治疗118例次,其中局部枸橼酸抗凝组行SLED枸橼酸抗凝56例次,普通肝素抗凝组行SLED肝素抗凝62例次.4例患者在住院期间因多器官功能衰竭死亡,余59例(93.7％)经SLED治疗后均好转出院或转为门诊规律血液透析.SLED 2 h时普通肝素抗凝组PT[(15.5 ±2.0)s]、APTT[(56.0±10.9)s]高于局部枸橼酸抗凝组[(12.3±2.7)s;(32.8±6.1)s],差异有统计学意义(P均＜0.001).SLED 5 h时PT[(12.2 ±2.9)s比(12.2±2.5)s]、APTT[(33.7 ±6.6)s比(32.5±6.6)s]两组比较差异无统计学意义(P均＞0.05).SLED治疗前后2组PLT差异无统计学意义(P均＞0.05).结论 局部枸橼酸抗凝与普通肝素的抗凝效果相当,出血风险相对小,为临床医生提供了更多的SLED抗凝选择.
目的 通過對比持續緩慢低效血液透析(SLED)中跼部枸櫞痠抗凝與肝素抗凝的效果,為臨床選擇更優化的抗凝方式提供依據.方法 行SLED的63例急性腎損傷或終末期腎病患者,隨機分為跼部枸櫞痠抗凝組和普通肝素抗凝組,均採用頸/股靜脈留置雙腔導管,費森尤斯公司生產的4008sARrTplus透析機和Polyflux 14L透析器,治療時間8h,血流量150 ml/min.治療前後測2組患者凝血酶原時間(PT)、APTT、PLT.結果 63例患者共行SLED治療118例次,其中跼部枸櫞痠抗凝組行SLED枸櫞痠抗凝56例次,普通肝素抗凝組行SLED肝素抗凝62例次.4例患者在住院期間因多器官功能衰竭死亡,餘59例(93.7％)經SLED治療後均好轉齣院或轉為門診規律血液透析.SLED 2 h時普通肝素抗凝組PT[(15.5 ±2.0)s]、APTT[(56.0±10.9)s]高于跼部枸櫞痠抗凝組[(12.3±2.7)s;(32.8±6.1)s],差異有統計學意義(P均＜0.001).SLED 5 h時PT[(12.2 ±2.9)s比(12.2±2.5)s]、APTT[(33.7 ±6.6)s比(32.5±6.6)s]兩組比較差異無統計學意義(P均＞0.05).SLED治療前後2組PLT差異無統計學意義(P均＞0.05).結論 跼部枸櫞痠抗凝與普通肝素的抗凝效果相噹,齣血風險相對小,為臨床醫生提供瞭更多的SLED抗凝選擇.
목적 통과대비지속완만저효혈액투석(SLED)중국부구연산항응여간소항응적효과,위림상선택경우화적항응방식제공의거.방법 행SLED적63례급성신손상혹종말기신병환자,수궤분위국부구연산항응조화보통간소항응조,균채용경/고정맥류치쌍강도관,비삼우사공사생산적4008sARrTplus투석궤화Polyflux 14L투석기,치료시간8h,혈류량150 ml/min.치료전후측2조환자응혈매원시간(PT)、APTT、PLT.결과 63례환자공행SLED치료118례차,기중국부구연산항응조행SLED구연산항응56례차,보통간소항응조행SLED간소항응62례차.4례환자재주원기간인다기관공능쇠갈사망,여59례(93.7％)경SLED치료후균호전출원혹전위문진규률혈액투석.SLED 2 h시보통간소항응조PT[(15.5 ±2.0)s]、APTT[(56.0±10.9)s]고우국부구연산항응조[(12.3±2.7)s;(32.8±6.1)s],차이유통계학의의(P균＜0.001).SLED 5 h시PT[(12.2 ±2.9)s비(12.2±2.5)s]、APTT[(33.7 ±6.6)s비(32.5±6.6)s]량조비교차이무통계학의의(P균＞0.05).SLED치료전후2조PLT차이무통계학의의(P균＞0.05).결론 국부구연산항응여보통간소적항응효과상당,출혈풍험상대소,위림상의생제공료경다적SLED항응선택.
Objective To compare the anticoagulation effect of regional citrate and heparin in patients with sustained low-efficiency hemodialysis (SLED).Method This study was conducted in the teaching hospital of Sichuan University between November 2011 and January 2013.Sixty-three patients suffering from acute kidney injury or end-stage renal diseases (ESRD) were enrolled and further randomized to 2 groups:citrate and heparin anticoagulation treatment groups in SLED.SLED was conducted by Fresenius 4008sARrTplus dialyzer for 8 hours each session,and blood flow was set at 150 ml/min.Prothrombin time (PT),activated partial thromboplastin time (APTT) and platelet (PLT) count were analyzed.Result Sixty-three patients underwent 118 sessions of SLED.Among them,59 patients (93.7％) was discharged after treatment or converted to outpatient intermittent hemodialysis,and 4 patients died of multiple organ failure during hospitalization.Compared with that in the citrate group,both PT and APTT in heparin group was significantly higher [PT:(15.5 ± 2.0) s vs (12.3 ± 2.7) s,P ＜ 0.001 ; APTF:(56.0 ± 10.9) s vs (32.8 ± 6.1) s,P ＜ 0.001 ; respectively] at 2 h during SLED.However,the PT and APTT levels in heparin group decreased afterwards and were similar with those in the citrate groups at 5 h during treatment.There is no difference on PLT counts between these two groups after treatment.Conclusion The anticoagulation effect of regional citrate and heparin was similar in patients when receiving SLED.Regional citrate may be an alternative anticoagulant approach for the patients at high risk of bleeding who require the treatment of SLED.
