肝素钠与枸橼酸钠封管液在人工肝治疗肝衰竭患者的应用比较*

目的 比较肝素钠与枸橼酸钠封管液在人工肝治疗肝衰竭患者中的有效性和安全性。方法 41例慢加急性乙型肝炎肝衰竭患者接受双重血浆分子吸附系统(DPMAS)序贯血浆置换(PE)治疗,在人工肝治疗后,分别采用肝素封管19例(79例次)和枸橼酸封管22例(80例次)。常规监测活化部分凝血活酶时间(APTT)。结果 在封管后2 h,枸橼酸封管组APTT为(65.6±12.2)s,显著短于肝素封管组的【(89.8±43.1)s,P<0.01】;肝素封管组和枸橼酸封管组疑似导管相关性感染发生率分别为5.3%(1/19)和0.0%(0/22),两组差异无统计学意义(P=0.46);两组患者3 m生存率(52.3%对54.5%)、住院日、自发性细菌性腹膜炎、肝性脑病、肝肾综合征和消化道出血等主要并发症发生率差异无统计学意义(P>0.05)。结论 在人工肝治疗后,应用4%枸橼酸钠封管有效,不会导致封管期间人体明显的凝血功能指标改变,可能更安全。

Comparison of citrate to heparin as a catheter locking solution in patients with liver failure undergoing artificial liver support therapy

Objective To assess the safety and efficacy of citrate to heparin as a catheter locking solution in patients with liver failure undergoing artificial liver support system(ALSS)therapy.Methods 41 patients with acute-on-chronic liver failure were recruited in our hospital,and all the patients received double plasma molecular absorption system(DPMAS)and sequential plasma exchange(PE).The citrate or heparin was used as locking catheter solution in 22 patients with 80 times and in 19 patients with 79 times,respectively.Blood activated partial thromboplastin time(APTT)were monitored.Results Two hours after locking,the blood APTT in citrate-locking was(65.6±12.2)s,significantly shorter than【(89.8±43.1)s,P<0.01】in heparin-locking;the incidences of catheter-related infection in the two groups was 0.0%(0/22)and 5.3%(1/19),respectively,without significant difference(P=0.46);there were no significant differences as respect to the 3-month survival(52.3%vs.54.5%),hospital stay,spontaneous bacterial peritonitis,hepatic encephalopathy,hepatic-renal syndrome and gastrointestinal bleeding in the two groups(P>0.05).Conclusions The application of citrate for catheter locking has a good approach in patients with liver failure undergoing ALSS therapy,without obvious alteration of coagulation index,which might be safer.