低浓度局部枸橼酸抗凝血液适析在高危出血并肾衰时的应用

目的：探讨高危出血合并肾功能衰竭患者在血液透析时，如何使用局部枸橼酸抗凝（ＲＣＡ）来完成血液透析及其疗效，方法：采用１．８％浓度的枸橼酸钠，空心纤维透析器和普通含碳酸氢盐透析液，观察ＲＣＡ透析对患者出血，体外循环凝血、血游离钙（Ｃａ＾２＋）、ｐＨ、ＨＣＯ３＾－、Ｓｃｒ、ＢＵＮ、ＨＲ的影响，同时设无肝素透析组普肝素透析组对照，观察透析效果，体外循环凝血时间（ＣＴ）及体内血ＣＴ、透析器复用时间的变化，结果：２６例急，慢性肾衰患者共行７９例次ＰＣＡ透析，未见有引起或加重出血者，透析器及管路未见发生严重凝血现象，无明显电解质、酸碱平衡紊乱症状，透析效果优于肝素治疗组，与普通肝素治疗组无显著性差异，结论：低浓度ＲＣＡ透析安全，有效，简便，适用于高危出血患者。

Application of Low Dose Citrate as Regional Anticoagulant for Hemodialysis in the Patients with Renal Failure Associated with High Risk Bleeding

Objective: To researeh on the use of low dose citrate as regional anticoagulant for hemodoalysis in patients with renal failune associated with high risk bleeding. Method: Hemodialysis was performed with using hollow fibes capillary dialyzer, and a general bicarbonate containing dialysate with 1.8% sodium citrate to observe effect of the dialysis conditions on hemorrhage,coagulation in extracorporeal circulation, plasma free calcium(Ca 2+ ), blood pH, HCO - 3, Scr , BUN and HR. Meanwhile, groups of using standard dialyaste with or without heparin were set as the control to observe the effectiveness of hemodialysis, the changes is cloting time (CT) of extracorporeal circulation and CT of system blood , and the times of dialyzer re using. Results : In the 26 patients with acute or chronic renal failure, total 79 hemodialysis operations with regional citrate anticoagulation were performed . There no hemorrhage or exacerbated hemorrhage was observed, also no clotting was found in the dialyzer and the tubing system, and no obvious disturbances of eletrolyte balance and acid base disequilibrium was found. The over all outcome of dialysis was as good as that of using heparin, but better than without heparin . Conclusion: Hemodialysis with low dose of citrate as regional anticoagulant is an effective, simple and safe way of hemodialysis for patients with acute or chromic renal failure associated with high risk bleeding.