高浓度枸橼酸钠抗凝在维持性血液透析中的安全性探讨

目的观察局部运用高浓度枸橼酸钠抗凝在维持性血液透析治疗中的疗效及安全性。方法有出血倾向患者组以30％枸橼酸钠体外抗凝透析，常规治疗组以低分子肝素抗凝透析作为对照，记录透析前、后实验室检查指标，计算尿素清除指数值，并观察透析器及管路凝血情况。结果枸橼酸钠抗凝组透析前、后Na^＋变化存在统计学差异，两组透析前、后Ca^2＋、pH、HCO3^-变化也存在差异，两组活化部分凝血活酶时间变化及尿素清除指数值无统计学差异。枸橼酸钠抗凝组未出现低钙、高钠及严重碱血症，且透析器、管路未发生I级以上凝血。结论局部高浓度枸橼酸钠运用于维持性血液透析是安全有效的抗凝方法。

Security of high concentration sodium citrate anticoagulation in maintenance hemodialysis

Objective To observe the efficacy and safety of the local use of high concentrations sodium citrate anticoagulation in the maintenance hemodialysis. Methods The group of patients with bleeding tendency were given 30% sodium citrate for extracorporeal anticoagulation in dialysis, and conventional treatment group as a control given low molecular weight heparin for dialysis anticoagulation. Before and after dialysis laboratory parameters were recorded, Kt/V values were calculated, and coagulation conditions of dialyzers and lines were observed. Results There was significant difference in Na^＋ changes before and after dialysis in sodium citrate anticoagulation group. There was also significant difference in changes of Ca^2＋ , pH, HCO3^- before and after dialysis in two groups. But changes of activated partial thromboplastin time and Kt/V values in two groups showed no significant difference. The symptoms of low calcium, high sodium and severe base acidosis were not observed in sodium citrate anticoagulation group,and coagulation above I level in dialyzers and lines did not occur. Conclusions The local use of high concentration sodium citrate might be a safe and effective anticoagulation method in maintenance hemodialysis.