局部枸橼酸钠抗凝技术在ICU高出血风险患者中的应用

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摘要目的探讨局部枸橼酸钠抗凝技术在重症监护病房（ICU）高出血风险患者中的应用价值。方法选取2016年3月～2018年5月解放军总医院第三医学中心ICU 收治的56例高出血风险患者作为研究对象，按照随机数字表法将其分为对照组（28例）与观察组（28例）。对照组患者采用局部肝素钠抗凝法，观察组患者则采用局部枸橼酸钠抗凝技术。比较两组的透析器及管路凝血情况、相关实验室指标的变化；记录所有患者治疗期间并发症发生情况。结果对照组行血液净化189例次，观察组行血液净化201例次，观察组的透析器及管路凝血发生率及严重程度均低于对照组，差异有统计学意义（P＜0.05）。治疗前，两组患者的Ca2+、血清Na+、碳酸氢根（HCO3-）、活化部分凝血活酶时间（APTT）以及尿素氮（BUN）、血肌酐（SCr）指标比较，差异无统计学意义（P＞0.05）；治疗后，两组患者均顺利完成血液净化治疗，其中观察组治疗后8 和12 h 时APTT 短于对照组，治疗后12 h 时HCO3-高于对照组，差异有统计学意义（P＜0.05）；两组患者治疗后其他各指标比较，差异无统计学意义（P＞0.05）。观察组患者的出血加重及新发出血发生率均低于对照组，差异有统计学意义（P＜0.05）。结论局部枸橼酸钠抗凝技术在ICU高出血风险患者血液净化治疗中的应用效果显著，其可有效改善ICU 血液净化伴高出血风险的凝血指标，降低出血风险，为患者节约医疗费用，值得推广。

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	杨四平
	张杰
	赵炳朕

关键词 ：局部肝素钠抗凝法, 局部枸橼酸钠抗凝, ICU, 高出血风险, 血液净化

Abstract：Objective To explore the application value of local Sodium Citrate anticoagulation in patients with high bleeding risk in intensive care unit (ICU).Methods From March 2016 to May 2018,56 patients with high bleeding risk admitted to the ICU of the Third Medical Center of PLA General Hospital were selected as the research subjects.According to the random number table method,they were divided into the control group (n=28) and the observation group(n=28).In the control group,local Heparin Sodium anticoagulation was used,and in the observation group,local Sodium Citrate anticoagulation was adopted.The coagulation status of the dialyzer and tubing,and the changes in related laboratory indicators were compared between the two groups.The incidence of complications during treatment for all patients was recorded.Results In the control group,blood purification was performed in 189 times,and in the observation group,the purification was performed in 201 times.The incidence and severity of coagulation in the dialyzer and tubing in the observation group were lower than those in the control group,and the differences were statistically significant (P＜0.05).Before treatment,there were no statistically significant differences in the indexes of Ca2+,serum Na+,bicarbonate (HCO3-),activated partial thromboplastin time (APTT),urea nitrogen (BUN) and serum creatinine (SCr) between the two groups (P＞0.05).After treatment,both groups successfully completed blood purification treatment.The APTT of the observation group was shorter than that of the control group at 8 and 12 h after treatment,HCO3-was higher than that of the control group at 12 h after treatment,and the differences were statistically significant (P ＜0.05).There were no statistically significant differences in other above-mentioned indicators after treatment between the two groups (P＞0.05).The incidence rates of hemorrhage aggravated and new bleeding in the observation group were lower than those in the control group,and the differences were statistically significant (P＜0.05).Conclusion The application effect of local Sodium Citrate anticoagulation in blood purification treatment of patients with high bleeding risk in ICU is remarkable.It can effectively improve the coagulation indicators of ICU blood purification with high bleeding risk,reduce bleeding risk,and save medical expenses for patients.It is worthy of promotion.

Key words： Local Heparin Sodium anticoagulation Local Sodium Citrate anticoagulation ICU High bleeding risk Blood purification

作者简介: 杨四平（1971-），男，重庆人，本科，主治医师，研究方向：急性肾损伤、心肺复苏、重症肺炎，主要从事危重患者抢救工作

引用本文:

杨四平；张杰；赵炳朕. 局部枸橼酸钠抗凝技术在ICU高出血风险患者中的应用[J]. 中国当代医药, 2020, 27(34): 16-20.
YANG Si-ping；ZHANG Jie；ZHAO Bing-zhen. Application of local Sodium Citrate anticoagulation in patients with high bleeding risk in ICU. 中国当代医药, 2020, 27(34): 16-20.

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https://www.dangdaiyiyao.com/CN/ 或 https://www.dangdaiyiyao.com/CN/Y2020/V27/I34/16

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