郭爽.枸橼酸抗凝与普通肝素抗凝在脓毒症急性肾损伤患者血液滤过中的应用对比[J].内科急危重症杂志,2016,22(4):
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| DOI： |
| 中文关键词: 普通肝素 枸橼酸 脓毒症 急性肾损伤 血液滤过 |
| 英文关键词:Heparin citrate sepsis acute kidney injury hemofiltration |
| 基金项目:河北省2014年度医学科学研究重点课题，医院感染病原菌流行病学特征及耐药性变化趋势（编号：ZD20140246） |
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| 中文摘要: |
| 目的：对比枸橼酸抗凝与普通肝素抗凝在脓毒症急性肾损伤患者血液滤过中的应用效果，以期得到更为有效的抗凝方案。方法：采用前瞻性研究方法，2012年12月至2015年12月选择在北京市昌平区医院MICU诊治的SAKI患者300例作为研究对象，根据随机平行对照组原则分为观察组与对照组各150例，两组都给予持续性血液滤过(CBP)治疗，对照组使用全身肝素抗凝，观察组使用枸橼酸抗凝抗凝，剂量都为10mg?kg-1，观察两组预后情况。结果：两组治疗后的BUN与Cr值都明显低于治疗前(P<0.05)，同时观察组治疗后的BUN与Cr值也明显低于对照组(P<0.05)。观察组与对照组治疗后的ACT值分别为117.30±13.49s和138.24±12.48s，而治疗前分别为114.29±10.59s和113.19±18.50s，观察组治疗后的ACT值明显少于对照组(P<0.05)。观察组有6例发生2级凝血；对照组有15例发生2级凝血，9例发生3级凝血，两组对比差异明显(P<0.05)。对照组的滤器寿命(25.90±7.66)h 明显低于观察组(37.80±5.72)h(P<0.05)。观察组出血发生率2.0%(3/150) 少于对照组14.0%(21/150)，28 d 病死率20.0%(30/150) 低于对照组38.00%(57/150)，对比差异明显(P<0.05)。结论：相对于普通肝素，枸橼酸抗凝在脓毒症急性肾损伤患者血液滤过中的应用能更有效发挥抗凝作用，能改善肾功能与显著延长滤器使用寿命，减少出血并发症，降低28 d 病死率，有很好的应用价值。 |
| 英文摘要: |
| Objective: To comparison effects of heparin and citrate anticoagulation in the sepsis acute kidney injury patients by the hemofiltration in order to get more effective anticoagulation regimen. Methods: Used a prospective study method, From December r 2012 to December 2015, 300 patients with sepsis acute kidney injury patients in MICU of changping district hospital were diagnosis and treatment were selected, accorded to the random parallel control group principle divided into observation group and control group, each of 150 cases, two groups were given continuous hemofiltration (CBP) treatment, the control group were used systemic anticoagulation with heparin, the observation group were uesed citrate anticoagulant, observed the outcomes in the two groups, The doses were 10mg and kg-1,. Results: The values of BUN and Cr in the two groups after treatment were significantly lower than those before treatment (P<0.05), and the value of BUN and Cr in the observation group after treatment were significantly lower than that in the control group (P<0.05). The ACT values in the observation group and control group after treatment were 117.30±13.49s and 138.24±12.48 respectively, and before treatment were 114.29±10.59s and 113.19±18.50s, the observation group after treatment of ACT value was significantly less than the control group (P<0.05). In the observation group, there were 6 cases of 2 grade of coagulation, the control group were 15 cases of 2 grade of coagulation, 9 cases of 3 grade of oagulation, the difference compared between the two groups was significant (P<0.05). The filter life (25.90±7.66)h of the control group was significantly lower than that of the observation group (37.80±5.72) h (P<0.05). The incidence of bleeding in the observation group were 2% less than the control group of 14%, the 28 d mortality of 20% were lower than the control group 38%, compared the difference were all significant (P<0.05). Conclusion: Compare with heparin, citrate anticoagulation in septic acute kidney injury patients with hemofiltration can more effectively play the anticoagulant effect, it can improve renal function and significantly extend the filter service life, reduce bleeding complications, reduce the 28 day mortality rate that has very good values. |
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