枸橼酸钠置换液在连续性肾脏替代治疗中的应用

目的　观察枸橼酸钠溶液在多脏器衰竭合并高危出血患者行连续性肾替代治疗 (CRRT)时的抗凝有效性和安全性。方法　 15例多脏器衰竭合并高危出血患者行连续性肾脏替代治疗时 ,给予含 13.3mmol/L的枸橼酸钠溶液为置换液 ,透析液为常规碳酸氢盐溶液 ,持续补钙 ,适量补镁 ,记录透析前、透析 4小时、透析 8小时、透析 2 4小时的血肌酐、尿素、血气分析、电解质、ACT、PT、APTT及TT的变化、管路及血滤器的凝血情况和使用时间 ,并观察治疗中不良反应。结果　治疗过程中患者生命体征平稳 ,出血无加重 ,电解质、血气指标稳定 ,肌酐、尿素清除效果明显 ,超滤可达目标值 ,体内的ACT、PT、APTT、TT均不延长 ,血滤器使用时间为 (2 4 .0± 9.2 )小时 ,范围 18～ 72小时 ,能够达到治疗要求。结论　枸橼酸盐置换液应用在多脏器衰竭合并高危出血患者行连续性肾替代治疗时 ,既不加重患者出血倾向 ,又能够达到临床治疗效果。

Application of sodium citrate substitution fluid in continuous renal replacement therapy

Objective To investigate the anticoagulative effect iveness and reliability of sodium citrate substitution fluid in continuous renal replacement therapy (CRRT) among patients with multiple organs failure(MOF) at high risk of bleeding. Methods CRRTs were performed in fifteen MOF patients at high ri sk of bleeding. The substitution fluid and dialysate were sodium citrate substit ution fluid and routine bicarbonate dialysate respectively. Calcium glyconate an d magnesium sulfate were continuously supplied during the treatment periods. Cli nical changes, blood gas analysis,serum creatinine,blood urea nitragen(BUN), ele ctrolyte, activated clotting time(ACT), prothrombin time(PT),activated partial thromboplastin time (APTT) and thromboplastin time(TT) at predialysis,4th hour, 8th hour and 24th ho ur in dialysis,the blood coagulation of tube pathways and blood filters were rec orded. As the same time, side effect were observed in therapy.Results All patients were kept stable vital signs, serum electro lyte and blood gas markers during the therapeutic periods. Moreover, ideal seru m creatinine and urea clearance rate and ultrafiltration rate were obtained in a ll subjects, but without deteriorated bleeding and significantly prolonged ACT,P T,APTT and TT. The blood filters longevity were in the range from 18 hours to 48 hours,the longest was 72 hours. Conclusion Ideal clinical therapeutic effects and improved hemo rrhagic tendency were achieved in MOF patients at high risk of bleeding using so dium citrate substitution fluid during CRRT. Sodium citrate;