高浓度枸橼酸钠抗凝及联机预制置换液在连续肾脏替代治疗中的应用

目的　探讨高浓度枸橼酸钠局部抗凝及联机预制的低钠、低碱基、含钙置换液和透析液在高出血风险患者连续性肾脏替代治疗中的价值。方法　应用高浓度枸橼酸钠局部抗凝技术 ,联机血滤机器预制的低钠、低碱基、含钙置换液和透析液为高出血风险的危重患者进行 2 0例次大置换量连续性静脉 静脉血液透析滤过 (CVVHDF) ,并与同时期行边缘肝素化抗凝的 18例次CVVHDF进行比较 ,观察其血液净化效果和不良反应。结果　肝素抗凝组发生 9例次出血或原有出血加剧 ,5例患者退出肝素抗凝组。枸橼酸钠组均顺利完成治疗单元 ,未观察到出血或原有出血加剧征象。两组患者平均血流速、总超滤量、置换量和透析器寿命的差异均无显著性。枸橼酸钠组治疗结束后 ,血清钠、pH值高于对照组 (P<0 .0 5 ) ,但均在正常范围内 ;其余生化指标在治疗前后的差异无显著性。结论　高浓度枸橼酸钠抗凝 ,联机预制低钠、低碱基、含钙透析用液进行大置换量CVVHDF简便、安全、有效 ,对于抢救高出血风险的危重患者具有一定的推广应用价值

High concentration sodium citrate as anticoagulant in continuous veno-veno hemodiafiltration for patients at high risk of bleeding

Objective To evaluate the anticoagulant high concentration sodium citrate, and online system prepared replacement fluid in continuous veno veno hemodiafiltration (CVVHDF) for patients at high risk of bleeding. Methods Twenty CVVHDF were performed with high concentration sodium citrate as anticoagulant and on line system produced low sodium, low base, calcium containing fluid as dialysate and replacement fluid. Eighteen CVVHDF used heparin as anticoagulant were performed as control. The parameters for blood coagulation and blood biochemistry were closely monitored. The doses of anticoagulants, calcium solution and other essential agents were adjusted according to the APTT value and biochemical parameters. The dialyser was flushed with physiological saline every 12 hours. Results Bleeding or bleeding aggravation was exacerbated demonstrating in 9 patients of the heparin group, and 5 of them dropped out. No bleeding occurred in the sodium citrate group. There was no difference in the hemodiafiltration parameters between the two groups. The level of serum sodium and arterial blood pH were higher in sodium citrate group than those in heparin group ( P <0.05 ), but still within normal ranges. The other biochemical parameters were comparable in both groups. Conclusion CVVHDF with high concentration sodium citrate as anticoagulant and with low sodium, low basic, calcium containing dialysate and replacement fluid was safe , convenient and effective for patients at high risk of bleeding.