两种枸橼酸钠置换液配方的抗凝效果比较

目的通过动物实验探讨两种不同剂量的枸橼酸钠置换液在血液滤过治疗过程中的抗凝效果。方法将建立急性肾功能衰竭模型的18只实验犬随机分为枸橼酸钠1组、枸橼酸钠2组与肝素组,每组6只。12h行血液滤过治疗,血流量为50ml/min、置换液速度为500ml/h。枸橼酸钠1组使用含1.5mmol/L枸橼酸钠的置换液,枸橼酸钠2组使用含0.5mmol/L枸橼酸钠的置换液,两组均在血滤管路静脉端持续补钙;肝素组使用低分子肝素20U/（kg·h）持续泵入;记录血液滤过前、血液滤过后每2h的血肌酐、尿素、血气分析、电解质、凝血指标的变化、管路及血滤器的凝血情况和使用时间。结果三组血滤治疗过程中均未有管路和血滤器堵塞现象,实验犬的电解质、血气分析、血肌酐、尿素结果三组无明显差异（P〉0.05）。两组枸橼酸钠组的实验犬体内的PT、PT%、PTINR、APTT、AT3%均不延长,纤维蛋白原浓度（Fbg）无明显下降。与两组枸橼酸钠组比较,肝素组在血流量为50ml/min、置换液速度为500ml/h时,体内的PT、PTINR、APTT均有延长（P〈0.01）。结论枸橼酸盐置换液应用血液滤过治疗时,浓度在0.5～1.5mmol/L范围内枸橼酸钠置换液有良好的抗凝效果,对体内内环境影响较少。

Sodium citrate substitution fluid in hemofiltration

Objective To investigate the anticoagulative effectiveness and reliability of sodium citrate substitution fluid in hemofiltration. Methods 18 health hybridize dogs were randomly divided into three groups： treatment group 1 and treatment group 2 were treated by two different concentration of sodium citrate together with continue supply of calcium glyconate （0.5 / 1.5 mmol / L）during the treatment periods; control group were treated by heparin. 12 hours after acute kidney failure, each group was given hemofiltration with blood flow of 50 ml / min, and replacement fluid of 500 ml / h. Blood gas analysis,serum creatinine, blood urea nitrogen （BUN）, electrolyte,prothrombin time （PT）,PT%, PT / R, PT INR, activated partial thromboplastin time （APTT）, AT3%, thromboplastin time（TT）and Fbg at predialysis,per 2 hour in dialysis,the blood coagulation of tube pathways and blood filters were recorded. Results There was no blocking of the blood filter system in all three groups. There were no significant differences of the electrolyte, blood gas analysis, plasma creatinine and urea between these three groups （P0.05）. In the two treatment groups the PT, PT%, PT / R, PT INR, APTT and AT3% were not extended. The concentration of fibrinogen （Fbg）showed no significant drop, while in the control group at the blood flow 50 ml/min and replacement liquid speed 500 ml/h, the PT, PT INR and APTT were extended （P0.01）. Conclusion Citrate hemofiltration replacement fluid at the concentration of 0.5 to 1.5 mmol / L has good anticoagulant effect and less impact on the body.