改良枸橼酸抗凝方案及血液灌流应用研究

目的：改良目前血液净化枸橼酸抗凝方案，减少灌流过程中堵管发生率及血红蛋白、血小板等减少，以及血液灌流对全身凝血机制的影响，研究其应用可行性。方法纳入初次行血液灌流病例随机进行目前通用血液灌流方案或改良后血液灌流方案，对照其灌流过程中灌流器及管路凝血情况及灌流前后患者血红蛋白、血小板、凝血时间、活化的部分凝血活酶时间、谷丙转氨酶、谷草转氨酶、白蛋白、尿素氮、肌酐变化情况。结果与对照组相比较改良后枸橼酸抗凝方案堵管发生率变化不明显，但其导致的血小板、血红蛋白减少，凝血时间及活化的部分凝活酶血时间延长等情况差异具有显著性。结论改良枸橼酸抗凝治疗方案，操作简便，对体内各相关指标影响较小，适宜临床应用。

Plan of improving regional citrate anticoagulation and study of hemoperfusion application

Objective To improve the current blood purification plan of improving regional citrate anticoagulation ,reduce the plugging occurrence rate and avoid hemoglobin and blood platelet decrease in the perfusion process ,and lower blood perfusion's influence on the whole body's clotting mechanism ,study the feasibility of its application .Methods Randomly conduct the cur‐rently common or improved blood perfusion proposal in the cases of initial blood perfusion ;in the perfusion process ,compare situations of hemoperfusion and pipeline coagulation ,and variation conditions of patients'hemoglobin ,blood platelet ,blood clot‐ting time ,activated partial thromboplastin time ,glutamic‐pyruvic transaminase ,glutamic oxalacetic transaminase ,albumin ,urea nitrogen and creatinine before and after the perfusion .Results Compared to the control group ,the improved plan of improving regional citrate anticoagulation plugging occurrence rate does not pose an obvious difference ,but in conditions which it leads to , such as decrease of blood platelet and hemoglobin and extended time of coagulation and activated partial thromboplastin ,there is a significant difference .Conclusion The improved treatment plan of regional citrate anticoagulation is easy to operate and has less impact on all the relevant internal indicators .It is suitable for clinical use .