局部枸椽酸抗凝在血液净化中应用的临床观察及护理

【摘要】 目的 探讨局部枸椽酸抗凝在连续性静脉血液滤过(CVVH)中应用的临床效果及护理体会。方法〓选取52例行静脉血液滤过的患者,按应用抗凝剂的不同分成A组和B组,A 组即局部枸椽酸抗凝组26例,B组即全身低分子肝素抗凝组26例。监测两组患者CVVH治疗前及治疗72小时后肾功能及出凝血情况、滤器及管道情况、护士工作时间。结果〓两组患者72小时后肌酐(238.6±81.2 vs. 245.0±75.4 umol/L, t=-0.295,P=0.769)、尿素氮(13.8±4.8 vs. 13.5±5.2 umol/L, t=0.257, P=0.798)、APACHEII评分(17.7±3.4 vs. 16.0±4.1, t=1.608 P=0.114)间差异均无统计学意义;出凝血功能(TT:18.8±4.1 vs. 19.6±4.3秒,t=-0.654、P=0.516,APTT:45.4±11.6 vs. 40.5±11.7秒,t=1.498、P=0.140,PLT:108.9±49.7 vs. 113.2±48.4×109/L,t=-0.312、P=0.756)、气道/各穿刺点出血人次(1 vs. 3人次,Χ2=1.083,P=0.298)的差异无统计学意义。但对于滤器及管道寿命,B组明显长于A组(48.78±12.83 vs. 17.67±6.49小时,t=-11.029,P=0),护士工作时间,前者亦明显少于后者(401.7±54.7 vs. 459.4±74.1分钟,t=3.195,P<0.05)。结论〓局部枸椽酸抗凝在血液净化中对肾脏功能影响、凝血功能变化与低分子肝素无差异,说明其安全、有效,但管道及滤器使用时间明显延长,明显减少管道及滤器更换次数,大大提高经济性同时大大减轻护士工作量。

Clinical observation and nursing of citron acid anticoagulation in continuous venovenous hemofiltration (CVVH)

【Abstract】 Objective〓To explore the clinical effect and nursing experience of citron acid anticoagulation in CVVH. Methods〓The total of 52 patients treated with CVVH were divided into two groups (Group A and Group B). The anticoagulation was selected citron acid in Group A (n=26) and low molecular weight heparin (LMWH) in Group B (n=26). The indexes of renal function, bleeding and coagulation, endurance of filter and pipelines and nurse working hours were recorded before and 72 hours after CVVH treatment in both groups. Results〓There was no significant difference of creatine 238.6±81.2 umol/l vs. 245.0±75.4 umol/l, t=1.664, P=0.130), urea nitrogen (13.8±4.8 vs. 13.5±5.2 umol/L, t=0.257, P=0.798) and APACHEII scores (17.7±3.4 vs. 16.0±4.1, t=1.608 P=0.114) in two groups. At the meantime, no significant difference was found in bleeding and coagulation (TT: 18.8±4.1 vs. 19.6±4.3Sec, t=-0.654、P=0.516,APTT:45.4±11.6 vs. 40.5±11.7Sec, t=1.498、P=0.140, PLT:108.9±49.7 vs. 113.2±48.4×109/L, t=-0.312、P=0.756 and bleeding from airway/puncture points (1 vs. 3 patients, Χ2=1.083,P=0.298) between two groups. But compared to Group B, the endurance of filter and pipelines (48.78±12.83 vs. 16.67±6.49 hours, t=-11.029,P=0) and nurse working hours (401.7±54.7 vs. 459.4±74.1min, t=3.195,P<0.05) were significantly different in Group A. Conclusion〓Citron acid anticoagulation was as safe and effective as LMWH anticoagulation in CVVH treatment but the former lowered nursing working load drastically.