枸橼酸钠局部抗凝在危重症患者连续性肾脏替代治疗中的应用效果分析

目的探讨枸橼酸钠局部抗凝在危重症患者连续性肾脏替代治疗中的应用效果。方法选取2015年11月至2018年2月在我院接受连续性肾脏替代治疗的危重症患者84例为研究对象,按照随机数字表法分为观察组和对照组,每组42例。对照组患者给予普通肝素进行抗凝,观察组患者给予4%枸橼酸钠局部抗凝。比较两组患者出血、凝血情况,治疗前后肾功能、电解质的变化情况以及不良反应发生情况。结果观察组患者的出血率(2.38%)明显低于对照组(19.05%),差异有统计学意义(P<0.05);两组患者的凝血率比较差异无统计学意义(P>0.05)。治疗24h后,观察组患者的Ca2+、HCO3-水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗后6个月,两组患者尿素氮(BUN)、血肌酐(Scr)水平均明显降低(P<0.05),但两组患者的BUN、Scr水平比较差异无统计学意义(P>0.05)。治疗期间,两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论在危重症患者连续性肾脏替代治疗中,枸橼酸钠局部抗凝效果显著,不影响患者肾功能,有利于维持患者电解质的稳定。

Application effect analysis of sodium citrate local anticoagulation in continuous renal replacement therapy on critically ill patients

Objective To explore the application effect of sodium citrate local anticoagulation in continuous renal replacement therapy on critically ill patients.Methods A total of 84 critically ill patients who underwent continuous renal replacement therapy in our hospital from November 2015 to February 2018 were selected and randomly divided into observation group and control group,with 42 cases in each group.The control group received unfractionated heparin for anticoagulation,and the observation group received 4% sodium citrate for local anticoagulation.The bleeding and coagulation condition,the changes of renal function and electrolytes as well as the occurrence of adverse reactions between the two groups were compared.Results The bleeding rate of the observation group (2.38%) was significantly lower than that in the control group (19.05%),and the difference was statistically significant ( P <0.05).There was no statistically significant difference in the coagulation rate between the two groups ( P >0.05).After treatment for 24 hours,the levels of Ca + and HCO 3 - in the observation group were significantly lower than those in the control group,and the difference was statistically significant ( P <0.05).Six months after treatment,the levels of urea nitrogen (BUN) and serum creatinine (Scr) in both groups were significantly decreased ( P <0.05);however,there was no statistically significant difference in BUN and Scr levels between the two groups ( P >0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups during the treatment period ( P >0.05).Conclusion Application sodium citrate local anticoagulation to continuous renal replacement therapy on critically ill patients can obtain effective anticoagulation,which shows little side effect on the renal function,and is beneficial to maintain electrolyte stability of the patients.