中国急救复苏与灾害医学杂志
中國急救複囌與災害醫學雜誌
중국급구복소여재해의학잡지
CHINA JOURNAL OF EMERGENCY RESUSCITATION AND DISASTER MEDICINE
2015年
7期
645-648
,共4页
重型颅脑损伤%急性肾功能衰竭%血液滤过%抗凝%枸橼酸盐%肝素
重型顱腦損傷%急性腎功能衰竭%血液濾過%抗凝%枸櫞痠鹽%肝素
중형로뇌손상%급성신공능쇠갈%혈액려과%항응%구연산염%간소
Severe brain injury%Acute renal failure%Hemofiltration%Anticoagulation%citrate%heparin
目的：重型颅脑损伤患者进行连续静脉静脉血液滤过（Continuous veno-venous hemofiltration，CVVH）时使用局部枸橼酸抗凝和全身普通肝素抗凝有效性和安全性比较。方法回顾性分析2008年12月~2014年12月我院重症医学科因急性肾功能衰竭接受CVVH治疗的64例重型颅脑损伤患者共行128次CVVH，按抗凝方式分为局部枸橼酸抗凝组（A组，70次）和全身肝素抗凝组（B组，58次），比较两组滤器寿命、血滤停止的原因。结果 A组滤器寿命明显长于B组[58.2h（35.6~72.4h）h对19.4 h（8.3~37.1 h），P<0.01]，Kaplan-Meier生存分析法显示两组滤器寿命差异有统计学意义（P<0.01）；因凝血导致血滤终止的比例B组为87.9%（51/58），显著高于A组44.3%（31/70）（P=0.001）。结论与全身普通肝素抗凝相比，重型颅脑损伤患者进行CVVH时采用局部枸橼酸抗凝，滤器寿命明显延长。
目的：重型顱腦損傷患者進行連續靜脈靜脈血液濾過（Continuous veno-venous hemofiltration，CVVH）時使用跼部枸櫞痠抗凝和全身普通肝素抗凝有效性和安全性比較。方法迴顧性分析2008年12月~2014年12月我院重癥醫學科因急性腎功能衰竭接受CVVH治療的64例重型顱腦損傷患者共行128次CVVH，按抗凝方式分為跼部枸櫞痠抗凝組（A組，70次）和全身肝素抗凝組（B組，58次），比較兩組濾器壽命、血濾停止的原因。結果 A組濾器壽命明顯長于B組[58.2h（35.6~72.4h）h對19.4 h（8.3~37.1 h），P<0.01]，Kaplan-Meier生存分析法顯示兩組濾器壽命差異有統計學意義（P<0.01）；因凝血導緻血濾終止的比例B組為87.9%（51/58），顯著高于A組44.3%（31/70）（P=0.001）。結論與全身普通肝素抗凝相比，重型顱腦損傷患者進行CVVH時採用跼部枸櫞痠抗凝，濾器壽命明顯延長。
목적：중형로뇌손상환자진행련속정맥정맥혈액려과（Continuous veno-venous hemofiltration，CVVH）시사용국부구연산항응화전신보통간소항응유효성화안전성비교。방법회고성분석2008년12월~2014년12월아원중증의학과인급성신공능쇠갈접수CVVH치료적64례중형로뇌손상환자공행128차CVVH，안항응방식분위국부구연산항응조（A조，70차）화전신간소항응조（B조，58차），비교량조려기수명、혈려정지적원인。결과 A조려기수명명현장우B조[58.2h（35.6~72.4h）h대19.4 h（8.3~37.1 h），P<0.01]，Kaplan-Meier생존분석법현시량조려기수명차이유통계학의의（P<0.01）；인응혈도치혈려종지적비례B조위87.9%（51/58），현저고우A조44.3%（31/70）（P=0.001）。결론여전신보통간소항응상비，중형로뇌손상환자진행CVVH시채용국부구연산항응，려기수명명현연장。
Objective To compare efficacy and safety of regional citrate anticoagulation with systemic heparin in continuous veno-venous hemofiltration (CVVH) for patients with severe brain disease. Methods A retrospective analysis was performed on 64 severe brain disease patients who were given a total of 128 CVVH treatments due to acute renal failure in between December 2008 and December 2014 in department of critical care medicine in our hospital. According to regional citrate anticoagulation, they were divided into citrate group (group A, N=70) and systemic heparin group (group B, N=58), and the filter life of two groups were compared, as well as the reasons for hemofiltration termination. Results There was a significantly longer in filer life of group A than group B, 58.2 hours (35.6~72.4 h) vs. 19.4 hours ( 8.3~37.1 h), P<0.01. Kaplan-Meier survival analysis revealed that difference between the two groups was statistically significant (P<0.01);due to proportion of blood clotting, the rate of group B’ s filter termination was 87.9%(51/58), significantly higher than group A’s 44.3%(31/70), (P=0.001). Conclusion Comparing with systemic heparin anticoagulation in patients with severe traumatic brain injury, using CVVH with regional citrate anticoagulation carries out a significantly longer filter life.
