枸橼酸钠抗凝在儿童血液净化中的有效性与安全性研究

目的:探讨局部枸橼酸钠抗凝(RCA)技术在儿童血液净化中的有效性和安全性。方法:将43例行连续性血液净化(CBP)治疗的患儿分为肝素抗凝组(20例)和枸橼酸钠抗凝组(23例)。观察两组治疗时间、滤器使用时间,滤器、静脉壶的凝血情况,治疗前及治疗过程中APTT及电解质、血气分析等指标。结果:(1)枸橼酸钠抗凝组平均治疗时间及滤器使用时间均要显著高于肝素抗凝组(P<0.05);(2)枸橼酸钠抗凝组滤器和静脉壶的凝血发生率和严重程度均明显低于肝素抗凝组(P<0.05);(3)枸橼酸抗凝组原有出血加重和新发出血发生率均明显低于肝素抗凝组,枸橼酸纳抗凝组在CBP治疗过程中未见新发出血(P<0.05);(4)肝素抗凝组治疗后APTT明显延长(P<0.05),枸橼酸钠抗凝组治疗前后APTT无明显变化(P>0.05);治疗后,肝素抗凝组较枸橼酸钠抗凝组APTT明显延长(P<0.05);(5)肝素抗凝组治疗前后内环境无明显变化(P>0.05),电解质、酸碱维持在正常范围;枸橼酸钠抗凝组治疗前后Na+、iCa2+I、总钙浓度维持在正常水平(P>0.05),治疗后pH、HCO-3呈逐步上升趋势,治疗12h后出现代谢性碱中毒(P<0.05);两组同一治疗时间点的Na+、iCa2+I、总钙浓度比较差异无统计学意义(P>0.05);治疗8h后,枸橼酸钠抗凝组pH、HCO-3较肝素抗凝组高,枸橼酸钠抗凝组最终有代谢性碱中毒(P<0.05)。结论:RCA在儿童血液净化治疗过程中可获得良好的局部抗凝效果,可以安全有效地用于儿童CBP治疗。     

血液透析应用低分子量肝素和普通肝素相关实验参数比较

目的 研究血液透析应用低分子量肝素和普通肝素抗凝时相关实验参数的变化。方法 22例血液透析的尿毒症患者分别用低分子量肝素和普通肝素抗凝,监测指标包括抗因子Xa活性(AFXa)、凝血酶时间(TT)和活化部分凝血活酶时间(APTT)。结果 应用低分子量肝素抗凝时APTT、TT在透析过程中延长不明显(P>0.05),普通肝素组APTT、TT于透析30分钟及透析结束时明显延长,甚至部分血液不凝。低分子量肝素组透析结束时血浆抗FXa活性较透析前有显著性差异,且透析后30分钟及透析结束时均明显高于普通肝素组(P<0.001)。结论 低分子量肝素抗凝作用同APFF、TT无一定相关,低分子量肝素抗凝作用可由抗-FXa水平作为可靠根据,低分子量肝素在血液透析抗凝过程中比普通肝素更为安全、有效。     

不同监测方法指导下的脓毒症凝血功能障碍患者的肝素抗凝治疗研究

目的:观察血栓弹力图与传统凝血指标监测指导下的脓毒症凝血功能障碍患者的肝素抗凝效果.方法:将105例DIC评分≥3分的脓毒症患者随机分为血栓弹力图(TEG)组、活化部分凝血活酶时间(APTT)组和安慰剂组.TEG组与APTT组于入院当天给予肝素连续输注,TEG组根据R值调整肝素输注剂量,APTT组根据活化部分凝血活酶时...     

阿加曲班与低分子肝素在连续性血液净化治疗抗凝中的对比研究

目的:探讨阿加曲班在连续性血液净化(CBP)治疗抗凝中的疗效及安全性.方法:将30例多器官功能障碍综合征(MODS)患者分成实验组和对照组,每组各15例,在行CBP治疗时,实验组采用阿加曲班注射液抗凝,对照组采用低分子肝素钙抗凝,CBP治疗中监测患者活化部分凝血活酶时间(APTT)、血管路动脉压、静脉压变化;观察管路、滤器凝血情况;观察患者有无组织器官出血等不良反应.结果:阿加曲班组治疗后4 h及8 h静脉端APTT明显增高,动脉端APTT也增高,但不如静脉端明显,而且治疗后恢复接近治疗破前水平.低分子肝素组滤器及或管路凝血发生率26.7%;阿加曲班组滤器及或管路凝血发生率6.7%.阿加曲班组滤器及或管路凝血或器官出血发生率有下降趋势,但无统计学差异(P>0.05).结论:本研究已观察到阿加曲班的体外抗凝效果有优于低分子肝素的趋势,而很少并发出血,可应用于伴有出血倾向的MODS患者行CBP治疗时的抗凝.     

高浓度枸橼酸钠与局部肝素体外抗凝在血液净化伴出血倾向患者中运用的效果

目的观察高浓度枸橼酸钠和局部肝素体外抗凝在血液净化伴出血倾向患者中运用的效果。方法 2015年9月,便利抽样法选取在第二军医大学长征医院南京分院肾内科需要行连续性血液净化(continuous blood purification,CBP)治疗的伴出血倾向患者27例为研究对象,按随机数字表法将其分为A、B两组。A组(14例)以高浓度枸橼酸钠抗凝行CBP治疗,B组(13例)以局部肝素体外抗凝行CBP治疗。记录两组患者治疗前后电解质、肌酐、血气及活化部分凝血活酶时间(partial thromboplastin time,APTT),并观察两组滤器及管路凝血情况。结果两组患者均顺利完成CBP治疗,在治疗中均发生滤器及管路Ⅰ级凝血各1例,未出现Ⅰ级以上凝血。A组患者透析后未发生高钠、低钙血症及严重的碱血症,未出现口唇、四肢麻木的低钙表现,患者均存在轻度碱血症,与枸橼酸抗凝呈碱性相关;B组患者在治疗8~12 h时,监测出血时间发现,APTT时间轻度延长。A组和B组患者各实验室指标的变化程度不同。结论对于具有出血倾向患者CBP治疗时,建议首选高浓度枸橼酸钠抗凝,其次是局部肝素体外抗凝。     

无肝素盐水冲洗法在连续性血液净化中应用与护理

目的探讨无肝素盐水冲洗法在连续性血液净化中如何使滤器寿命延长,从而达到最佳疗效。方法选取入住ICU患者40例,行无肝素盐水冲洗法连续性血液净化治疗40次,分Ⅰ组与Ⅱ组,各20次,当跨膜压达到300 mmHg时,Ⅰ组继续30 min以125 mL生理盐水冲洗,Ⅱ组通过采取增加血流速、停止生理盐水冲洗、减少脱水量、减少置换液量的方法,观察跨膜压变化及滤器凝血程度。结果Ⅱ组比Ⅰ组跨膜压下降(40±20)mmHg,滤器寿命延长(6±2)h。结论无肝素抗凝时,护士通过及时采取增加血流速、停生理盐水冲洗、减少脱水量、减少置换液量的方法能有效降低跨膜压,有效延长滤器寿命。     

不同浓度肝素封管液对常规凝血功能和血栓弹力图的影响

目的探讨不同浓度肝素封管液对常规凝血功能和血栓弹力图(TEG)的影响。方法行局部枸橼酸抗凝的连续性肾脏替代治疗(CRRT)患者50例,根据肝素封管浓度不同随机分为两组:A组6250U/ml,B组3125U/ml。于CRRT前、CRRT后(封管前)及封管后30min检测血常规、凝血功能和TEG,封管30min后加作TEG肝素酶检测,记录24h内有无出血及血栓形成。结果 1血小板及常规凝血功能变化2组CRRT前后,血小板(PLT)及凝血酶原时间(PT)、部分凝血酶原时间(APTT)、凝血酶时间(TT)均无明显变化(P0.05);封管后30min,2组PT、APTT及TT较封管前均延长(P0.05),A组APTT及TT较B组明显延长(P0.05)。3TEG R值变化2组CRRT前后TEG R值无明显变化(P0.05),封管后30min R值均明显延长(P0.05),A组延长较B组更明显(P0.05)。A组有9例不凝血,B组有5例不凝血。经肝素酶中和后,2组R值均恢复正常。3不良事件发生情况2组均无血栓形成,A组出血事件多于B组(P0.05)。其中7例出血明显者经监测TEG给予鱼精蛋白中和肝素,出血停止,R值恢复正常。结论 CRRT患者应用6250U/ml及3125U/ml肝素封管后处于高危出血状态。TEG检查可以用来指导判断CRRT患者出血原因,以及确定鱼精蛋白中和剂量。     

改良式枸橼酸钠与低分子量肝素在急性肾损伤CRRT中的抗凝效果比较

目的比较两种抗凝方式在急性肾损伤(AKI)患者连续性肾脏替代治疗(CRRT)中的应用效果。方法选取新乡市第一人民医院肾病风湿免疫科2017年7月至2019年7月收治的96例行CRRT的AKI患者作为研究对象,将其随机分为参照组(n=48)和观察组(n=48)。参照组给予低分子量肝素进行抗凝,观察组给予3%枸橼酸钠进行局部抗凝。比较两组患者的前3 d有效治疗剂量、血滤器抗凝效果、活化部分凝血活酶时间(APTT)、血小板(PLT)、血肌酐(SCr)、总胆红素(TB)水平、出血不良事件发生情况。结果观察组的前3 d有效治疗剂量高于参照组(P<0.05)。观察组的血滤器凝血情况优于参照组,血滤器使用时间长于参照组(P<0.05)。治疗后,两组的APTT均延长,但观察组短于参照组(P<0.05);治疗后,两组的PLT、SCr、TB水平均降低(P<0.05),但组间比较,差异无统计学意义(P>0.05)。两组的出血不良事件总发生率比较,差异无统计学意义(P>0.05)。结论改良式枸橼酸钠应用于AKI患者CRRT中的局部抗凝效果较佳,可提高前3 d有效治疗剂量,延长血滤器使用时间,减少患者治疗期间出血风险,且对PLT、SCr、TB水平影响较小。     

不同抗凝方式下连续组静脉-静脉血液滤过透析治疗对凝血及透析滤器使用寿命的影响研究

目的观察低分子肝素全身抗凝和枸橼酸局部抗凝在连续性静脉-静脉血液滤过透析(CVVH)时滤器使用寿命的比较研究。方法回顾性分析2016年1-4月54例患者行128例次CVVH的治疗情况,按照抗凝方式不同分为枸橼酸钠组和低分子肝素组,对两组患者的临床资料、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、滤器使用时间及疗效进行比较。结果两种抗凝方式下均取得显著疗效,枸橼酸钠组滤器及管路平均使用寿命显著长于低分子肝素组。结论枸橼酸局部抗凝技术在延长滤器使用时间方面有明显优势,且对患者凝血指标影响较小。     

ICU中高出血风险患者血液滤过治疗的抗凝策略分析

目的:观察ICU中高出血风险患者进行床旁血液滤过治疗的不同抗凝方法的安全性及可行性。方法:将57例符合纳入标准的患者随机分为抗凝组(n=24例)和无抗凝组(n=33例),比较2组患者血液滤过过程中管路及滤器的使用寿命、清除效率及出血发生率。结果:使用肝素加鱼精蛋白的抗凝组与无抗凝组进行比较,显示抗凝组管路寿命明显延长,清除肌酐效果更好,差异有统计学意义(P0.05)。另抗凝组造成活化部分凝血活酶时间(APTT)延长,血小板下降发生率增加(P0.05),但血滤治疗后的出血发生率差异无统计学意义(P0.05)。结论:ICU中高出血风险患者进行床旁血液滤过治疗时给予肝素加鱼精蛋白的抗凝方式是相对安全的,保证了治疗效果,达到了治疗目标。     

Conventional coagulation and thromboelastograph parameters and longevity of continuous renal replacement circuits

OBJECTIVE: To determine the relationship between conventional and thromboelastograph (TEG) coagulation parameters and continuous renal replacement therapy (CRRT) circuit longevity. DESIGN: Conventional coagulation and TEG parameters were measured at the commencement of and during CRRT. Time to circuit cessation was measured and only circuits reaching a predetermined rise from baseline in the pressure gradient across the haemofilter were diagnosed as failing due to clotting. All other circuits were excluded from analysis. SETTING: A general critical care unit of a metropolitan tertiary hospital. PATIENTS AND PARTICIPANTS: Fourteen consecutive patients requiring CRRT were studied. The CRRT technique used was continuous veno-venous haemodialysis. INTERVENTIONS: Thromboelastograph measurements were made prior to the commencement of CRRT and daily thereafter for each circuit. The international normalised ratio (INR), activated partial thromboplastin time (APTT) and platelet numbers were measured at commencement and 8 hourly thereafter. Heparin was used for anticoagulation unless considered contraindicated. MEASUREMENTS AND RESULTS: Forty-seven circuits with a mean (SD) circuit life of 33.0 (30.2) h were entered. Twenty-five circuits fulfilled circuit clotting criteria; the mean circuit life was 30.8 (22.1) h. Heparin anticoagulation was found to prolong circuit life significantly despite adequate mean circuit life, 33.2 (35.7) h, in heparin-free circuits. The starting APTT and the TEG variables reaction time (R) and coagulation time (RK) were significantly correlated. The starting APTT, starting RK and mean time taken for the amplitude to increase from 2 to 20 mm (K) were predictive of circuit life. None of these variables predicted which patients would need heparin. CONCLUSION: While TEG variables more closely predicted circuit longevity than conventional coagulation variables, the clinical benefit of TEG monitoring of anticoagulation for CRRT would appear to be minimal.     

重症患者连续性肾脏替代治疗中管路寿命影响因素的研究

目的探讨影响重症病患者连续性肾脏替代治疗(CRRT)中管路寿命的因素。方法将131个因为管路凝结而更换配套的滤器分成两组,寿命<48h的为A组(106个),≥48h的为B组(25个)。比较两组管路滤器应用时患者的血清白蛋白、红细胞压积、血小板计数、离子钙浓度、pH值、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、肝素剂量及体温的变化,并采用多因素线性回归对上述指标进行分析。结果 B组患者血清离子钙浓度、pH值及体温明显低于A组患者(P均<0.05)。血PH值及离子钙浓度是影响管路滤器寿命≥48h的相关因素。结论影响CRRT管路寿命≥48h的相关因素是血pH值和离子钙浓度。     

精益管理在危重患者连续性肾脏替代治疗流程中的应用

目的：探讨精益管理在危重患者连续性肾脏替代( CRRT)治疗流程中的应用效果。方法选取本院2015年8月至12月实施精益管理的连续性肾脏替代治疗的危重患者50例为观察组,选取本院2015年3月至7月实施常规管理的连续性肾脏替代治疗的危重患者50例为对照组,比较两组的连续性肾脏替代治疗的效率、并发症及各方面护理满意度。结果观察组的CRRT准备时间、上机时间、下机时间均短于对照组,滤器寿命长于对照组,差异有统计学意义( P<0.05);观察组的血液过滤器凝血、渗血、血压下降等并发症低于对照组,差异有统计学意义( P<0.05);观察组的患者、护士及医生的满意度均高于对照组,差异有统计学意义( P<0.05)。结论精益管理能够提高CRRT的治疗效率,减少并发症的发生,提高患者及医护人员的护理满意度。     

Is regional citrate superior to systemic heparin anticoagulation for continuous renal replacement therapy? A prospective observational study in an adult regional critical care system

PURPOSE: Continuous renal replacement therapy (CRRT) is commonly used in the care of critically ill patients although the optimal means of anticoagulation is not well defined. We report our regional CRRT protocol that was developed using the principles of quality improvement and compare the effect of regional citrate with systemic heparin anticoagulation on filter life span. MATERIALS AND METHODS: Prospective observational cohort study in a Canadian adult regional critical care system. A standardized protocol for CRRT has been implemented at all adult intensive care units in the Calgary Health Region since August 1999. All patients with acute renal failure treated with CRRT during October 1, 2002, to September 30, 2003, were identified and followed up prospectively until hospital discharge or death. RESULTS: Eighty-seven patients with acute renal failure requiring CRRT were identified, 54 were initially treated with citrate, 29 with heparin, and 4 with saline flushes. Citrate and heparin were used in 212 (66%) and 97 (30%) of filters for 8776 and 2651 hours of CRRT, respectively. Overall median (interquartile range) filter life span with citrate was significantly greater than heparin (40 [14-72] vs 20 [5-44] hours, P < .001). The median time to spontaneous filter failure was significantly greater with citrate compared with heparin (>72 vs 33 hours, P < .001). Citrate anticoagulation resulted in greater completion of scheduled filter life span (59% vs 10%, P > .001). Citrate anticoagulation was well tolerated with no patient requiring elective discontinuation for hypernatremia, metabolic alkalosis, or hypocalcemia. CONCLUSIONS: Regional citrate anticoagulation was associated with prolonged filter survival and increased completion of scheduled filter life span compared with heparin. These data support small studies suggesting that citrate is a superior anticoagulant for CRRT and suggest the need for a future definitive randomized controlled trial.     

持续性肾脏替代治疗在脓毒症诱发多脏器功能失常综合征患者中的应用价值

目的 探讨持续性肾脏替代治疗(continuous renal replacement therapy,CRRT)在脓毒症诱发多脏器功能失常综合征(multiple organ dysfunction syndrome,MODS)患者中的应用价值.方法 天津医科大学第二医院院ICU的62例脓毒症导致MODS患者,按CRRT时间分为非CRRT组、短CRRT组(24～48 h)和长CRRT组(>48 h).观察各组脏器功能、血浆内皮素-1(ET.1)、脓毒症相关器官衰竭(SOFA)评分、生存时间和累计生存率的变化.结果 其中长CRRT组的SOFA评分逐渐下降于第4天处于相对低值,与非CRRT组相比较,差异具有统计学意义(P<0.05);而短CRRT组的SOFA评分逐渐下降于第6天处于相对低值,与非CRRT组相比较差异具有统计学意义(P<0.05).非CRRT、短CRRT和长CRRT的3 d生存率分别为56.3%、83.3%和88.9%,差异具有统计学意义(P<0.05);三组3周生存率分别为53.1%、58.3%和66.7%,差异无统计学意义(P>0.05).生存时间分别为非CRRT组(4.4±2.6)d,短CRRT组(9.5±6.1)d和长CRRT组(10.3±5.4)d,与非CRRT组相比,短CRRT组和长CRRT组患者的生存时间明显长于非CRRT组(P<0.05).患者血浆ET-1在CRRT治疗后明显下降(P<0.05).结论 CRRT能有效改善MODS患者的脏器功能,适当地延长CRRT时间可以明显降低SOFA评分,提高患者短期生存率.

Abstract：

Objective To study the values of continuous renal replacement therapy (CRRT) for the treatment of multiple organ dysfunction syndrome ( MODS) induced by sepsis. Methods A total of 62 patients with MODS were divided into three groups, namely non-CRRT group, short period CRRT group (24 ~ 48 h) and long period CRRT group( >48 h). Relevant factors including organ function, plasma endothelin-1 (ET-1),sepsis-related organ failure assessment(SOFA)score, average length of survival time and accumulative survival rate were analyzed . Results Compared with non-CRRT group, a statistically significant difference in SOFA score was evident on the 4th day after long period CRRT group and on the 6th day after short period CRRT group. The survival rates of three groups on the third day after treatment were 56. 3% 、 83.3% and 88.9%, respectively (P< 0.05). The survival rates of three groups three weeks after treatment were 53. 1% , 58. 3% and 66.7% , respectively (P>0.05). The average lengths of survival time in three groups were(4.4 ±2.6)days, (9.5 ±6. l)days and (10.3 ±5.4)days, respectively. Compared with non-CRRT group, the average lengths of survival time were longer in the other two groups. The levels of serum ET-1 significantly decreased after CRRT treatment (P<0.05). Conclusions The organ function and survival rate could be improved by CRRT. Average lengths of survival time were significantly prolonged in two CRRT groups(P <0.05). More effective therapeutic results including lower SOFA score and longer average length of survival time were observed when the course of CRRT was extended longer properly.     

Continuous veno-venous hemofiltration without anticoagulation in high-risk patients

OBJECTIVE: To study the safety and operative efficacy of continuous veno-venous hemofiltration (CVVH) without anticoagulation in patients at high risk of bleeding. DESIGN: Prospective cohort study and comparison to control group. SETTING: Tertiary, multidisciplinary intensive care unit. PATIENTS: Forty hemofiltration circuits in 12 patients with severe acute renal failure (ARF) deemed at high risk of bleeding. Forty control circuits in 14 patients treated with low-dose pre-filter heparin infusion. INTERVENTIONS: CVVH at 21/h of pump-controlled ultrafiltration without anticoagulation or saline flush in patients at high risk of bleeding. Collection of data at the bedside. MEASUREMENTS AND MAIN RESULTS: Mean circuit life was 32 h (95% CI: 20-44.4) in patients receiving CVVH without anticoagulation. Forty-three per cent of filters lasted longer than 30 h. Circuit lifespan did not correlate with international normalized ratio (INR), activated partial thromboplastin time (APTT) or platelet count. There were no bleeding complications and azotemic control was not compromised by lack of circuit anticoagulation with a mean serum urea of 16.0 mmol/l (95% CI: 14.9-18.1) during treatment. A control group of consecutive similarly ill patients not at high risk of bleeding received low-dose pre-filter heparin (mean dose 716 IU; 95% CI: 647-785). Their mean filter life was 19.5 h (95% CI: 14.2-23.8), significantly shorter than in the study patients (p = 0.017). CONCLUSIONS: Critically ill patients at high risk of bleeding who require continuous renal replacement therapy (CRRT) can be safely managed without circuit anticoagulation. This strategy minimizes bleeding risks and is associated with an acceptable filter life. CRRT without anticoagulation should be strongly considered in high-risk patients.     

集束化护理干预对老年危重症患者行无肝素连续性肾脏替代治疗的影响

目的探讨集束化护理干预对老年危重症患者行无肝素连续性肾脏替代(CRRT)治疗的影响。方法选取本院收治的行CRRT治疗的老年危重症患者94例作为研究对象,将其随机分为观察组和对照组,各47例。其中对照组给予常规护理干预,观察组在对照组基础上给予集束化护理干预。观察2组并发症发生率、滤器使用情况以及患者依从性情况。结果观察组感染、低体温、体外循环凝血、酸碱度失衡、出血、低血压、水电解质失衡发生率低于对照组(P0.05);观察组每个滤器使用时间、滤器使用总时间以及24 h使用滤器个数低于对照组(P0.05);观察组依从率91.49%,高于对照组的76.60%(P0.05)。结论集束化护理干预可有效降低老年危重症患者行CRRT治疗的并发症,减少滤器更换,并提高患者治疗依从性。     

基于前馈控制的护理干预对CRRT患者非计划性下机率的影响

目的 探讨基于前馈控制的护理干预对连续肾脏替代疗法(CRRT)患者非计划性下机率的影响.方法 选取2019年1月至2020年12月本院收治的300例CRRT患者作为研究对象,根据随机数字表法将其分为对照组(150例,常规护理干预)和观察组(150例,基于前馈控制的护理干预).比较两组患者的非计划性下机发生情况、治疗相关...     

连续性肾脏替代疗法治疗肝性脑病型重型肝炎的临床研究

目的 :探讨连续性肾脏替代疗法 (CRRT)治疗肝性脑病型重型肝炎临床疗效 ,并研究其机制。方法 :4 7例肝性脑病型重型肝炎患者随机分成 3组 :CRRT治疗组、血浆置换 (PE) +CRRT治疗组和基础疗法组 ,前两组在基础疗法组基础上分别予 CRRT或 PE+CRRT治疗。治疗前后检测肝、肾功能 ,血氨 ,肿瘤坏死因子 α(TNFα) ,白介素 6 (IL 6 )等。结果 :CRRT治疗组、PE+CRRT治疗组和基础疗法组患者的清醒率分别为 75 .0 %、86 .7%和 31.3% ,存活率分别为 2 5 .0 %、4 6 .7%和 6 .2 5 % (P均 <0 .0 5 )。CRRT治疗后血清尿素氮、肌酐、血氨、TNFα、IL 6比基础疗法组明显下降 (P均 <0 .0 5 ) ;血清胆红素、总胆汁酸 (TBA)下降和基础疗法组比较无显著变化 (P均 >0 .0 5 )。 CRRT治疗过程中血流动力学稳定 ,并发症少。 CRRT治疗组、PE+CRRT治疗组肝性脑病 ～ 期患者的存活率分别为 4 4 .4 %和 6 2 .5 % ,明显高于 ～ 期患者的存活率 0和2 8.6 % (P<0 .0 5 )。结论 :CRRT是辅助治疗肝性脑病型重型肝炎的有效方法 ;早期联合 PE治疗能进一步提高疗效     

枸橼酸抗凝联合CRRT治疗急性肾损伤患者的疗效及对血清CK-MB、BUN水平的影响

目的分析枸橼酸抗凝联合连续性肾脏替代治疗(CRRT)治疗急性肾损伤患者的疗效及对血清肌酸激酶同工酶(CK-MB)、血尿素氮(BUN)水平的影响。方法选择2016年1月至2018年6月在该院进行治疗的急性肾损伤并进行血液透析的患者112例作为研究对象,随机分为对照组(n=56)和观察组(n=56)。对照组采用肝素抗凝联合CRRT治疗,观察组采用枸橼酸抗凝联合CRRT进行治疗。对两组患者肝肾功能、炎症因子进行评估。结果治疗后,观察组患者血清肌酐、BUN、CK-MB、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、血清凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、凝血酶时间(TT)、白细胞介素(IL)-1、IL-6、IL-10,肿瘤坏死因子-α(TNF-α)均显著低于对照组,差异有统计学意义(均P<0.05)。结论枸橼酸联合CRRT能够提高血液净化效率,维持机体凝血功能正常,抑制炎性反应,具有较好的临床应用价值。