3种不同抗凝剂在CRRT治疗中抗凝疗效及安全性分析

目的观察比较普通肝素、低分子肝素和枸橼酸钠3种抗凝剂在连续性肾脏替代疗法(CRRT)治疗中的抗凝效果及对其安全性进行分析评价。方法选择2013年1月至2014年8月于该院进行CRRT治疗的72例患者作为研究资料,双盲法随机分为普通肝素组(A组)、低分子肝素组(B组)和枸橼酸钠组(C组),每组各24例。比较3组的抗凝有效性(血滤器有无凝血发生及血滤器寿命)、安全性(治疗前后活化部分凝血活酶时间、血小板计数、肌酐和总胆红素变化)、出血并发症事件(48h内股静脉/颈静脉穿刺点、消化道和皮肤黏膜等有无出血)。结果 C组血滤器抗凝效果显著优于A、B组,差异具有统计学意义(P0.05),A组血滤器使用寿命显著低于B、C组(P0.05),但B、C组血滤器使用寿命比较,差异无统计学意义(P0.05);治疗前A、B、C组患者活化部分凝血活酶时间、血小板计数、肌酐和总胆红素比较,差异无统计学意义(P0.05)。治疗后C组活化部分凝血活酶时间与A、B组相比,明显升高(P0.05)。治疗后B、C组血小板计数、肌酐和总胆红素指标比较差异无统计学意义(P0.05),但均显著优于A组(P0.05);A组共发生8例出血并发症事件,发生率为33.3%,与B、C组相比,差异有统计学意义(P0.05)。结论枸橼酸钠及低分子肝素在增加血滤器使用寿命、减少血小板减少症及出血并发症方面均具有较理想的效果,在充分遵循个体化原则的基础上,可优先考虑枸橼酸钠,以确保CRRT顺利进行。

Three different anticoagulants in the treatment of CRRT efficacy and safety analysis

Objective To compare the curative effect of unfractionated heparin ,low molecular heparin ,sodium citrate three anticoagulants in CRRT anticoagulation effect and evaluate their security .Methods Totally 72 patients in the hospital treated by CRRT from January 2013 to August 2014 were taken as research materials ,double blind method were randomly divided into unfractionated heparin group (group A ) ,low molecular weight heparin group (group B)and sodium citrate group(C group) ,with 24 cases in each group .The anticoagulant effectiveness(blood fil‐ter with and without coagulation and blood filter life) ,safety(treatment before and after the APTT ,PLT ,Cre ,TB changes)and bleeding complications(within 48 hours of the femoral vein /jugular vein puncture point ,digestive tract , skin and mucous membrane events there is no bleeding)were compared in three groups .Results The anticoagulant effect of C group was significantly better than that of A and B two groups ,with statistical significance(P<0 .05) . The service life of A group was significantly lower than that of B and C two groups(P<0 .05) ,but the B and C two groups of blood filter service life compared ,statistical difference was not obvious(P>0 .05) .Before treatment ,A ,B , C three groups of patients with APTT ,PLT ,Cre ,BT comparison ,there was no significant statistical difference(P>0 .05) .After treatment ,the APTT group C was significantly higher(P>0 .05)compared with the two groups of B and A .After treatment ,There was no significant difference of PLT ,Cre ,BT indicators in B and C group(P>0 .05) , but was significantly higher than that of group A(P<0 .05);A group had 8 cases of bleeding complications and the incidence rate was 33 .3% .There were statistical significance when compared with group B and group C(P<0 .05) . Conclusion Sodium citrate and low molecular weight heparin has ideal effect in increasing blood filter life ,reducing hit and bleeding complications .The sodium citrate should be given priority to ensure the smooth progress of CRRT on the basis of principle of individual .