枸橼酸钠抗凝在危重患者连续性血液净化治疗中的应用

目的评估枸橼酸钠抗凝在危重患者连续性血液净化治疗中的安全性和有效性。方法61例危重患者随机分为局部枸橼酸钠抗凝组（RCA组）38例和肝素组（对照组）23例，均行连续性血液净化治疗。监测活化凝血时间（ACT）、iCa、血Na＋、尿素氮、肌酐等，观察体外循环凝血情况。结果RCA组滤后ACT值均较滤前显著延长（P〈0．05）。对照组治疗后ACT值较RCA组显著延长（P〈0．05）。RCT组滤器凝血分级、静脉壶凝血分级明显优于对照组俨〈0,05）。RCA组治疗前后pH、血Na＋及血HCO3-未发现显著性变化（P〉0．05）。两组治疗后Cr、BUN均较治疗前显著降低（P〈0．05）。RCA组尿氮较对照组下降明显。结论局部枸橼酸钠在危重患者连续性血液净化时抗凝效果确切，并发症少，值得推广使用。

Application of anticoagulation with sodium citrate in continuous blood purification for critically ill patients

Objective To assess the safety and efficacy of anticoagulation with sodium citrate in continuous blood purification for critically ill patients. Methods 61 patients were randomly divided into sodium citrate group （n=38） and heparin group （control group, n = 23）. Both groups received continuous blood purification. Activated clotting time （ACT） and levels of Ca, Na＋, urea nitrogen, and creatinine were determined; coagulation in extracorporeal circulation was observed. Results ACT was markedly prolonged after hemofihion in RCA group as compared with the baseline （P〈0.05）. ACT was significantly longer in the control group than in RCA group after treatment （P〈0.05）. The filter clotting grading and the clotting grading of venous pot were significantly better in RCT group than in the control group （P〈0.05）. pH, Na＋ and HCO3-1 had no significance in RCA group before and after treatment （P〉0.05）. Cr, BUN were significantly lower after treatment （P〈0.05）. BUN was significantly decreased. Conclusions Topical sodium citrate anticoagulation for patients undergoing continuous blood purification is efficacious and has fewer complications. It is worth popularizing.