不同抗凝方式在连续性肾脏替代治疗急性肾损伤患者中的疗效及安全性比较
Eifficacy and safety of different anticoagulation methods in continuous renal replacement therapy in acute kidney injury patients

贾超.不同抗凝方式在连续性肾脏替代治疗急性肾损伤患者中的疗效及安全性比较[J].内科急危重症杂志,2019,25(2):133-135

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DOI：10.11768/nkjwzzzz20190213

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基金项目:四川省医学科研青年创新课题计划基金（No:Q16040）

作者	单位	E-mail
贾超	四川绵阳市中心医院	daixy001@163.com

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中文摘要:

目的：比较2种不同抗凝方式在行连续性肾脏替代治疗(CRRT)的重症急性肾损伤(AKI)患者中的疗效及安全性。方法：选取重症监护病房（ICU）接受CRRT治疗的AKI患者70例，按照随机数字表法分为低分子肝素组和枸橼酸钠组，每组35例。比较2组前3天平均每日有效治疗剂量、滤器寿命、ICU住院时间、患者28、90d生存率及不良反应。结果：前3天低分子肝素组平均每日有效治疗剂量低于枸橼酸钠组\[(27.7±0.98)mL/(kg•h) vs (28.8±1.91)mL/(kg•h),P<0.05\]。枸橼酸钠组滤器寿命明显长于低分子肝素组\[（44.4±7.63）h vs（27.3±9.69）h,P<0.01\]。枸橼酸钠组28d和90d生存率高于低分子肝素组，ICU住院时间短于低分子肝素组，但差异无统计学意义（均P>0.05）。低分子肝素组出现2例消化道出血，枸橼酸钠组未出现明显不良反应。结论：ICUAKI患者CRRT治疗中枸橼酸钠抗凝在前3天平均每日有效治疗剂量、滤器寿命等方面均优于低分子肝素，且治疗过程中未发现明显不良反应。

英文摘要:

Objective: To explore the efficacy and safety of two anticoagulation methods for continuous renal replacement therapy (CRRT) in critical patients with acute kidney injury (AKI). Methods: A total of 70 AKI patients treated with CRRT 〖JP2〗were randomly divided into low molecular weight heparin (LMWH) group (group A) and citrate group (group B). Each group had 35 cases. Effective daily delivered CRRT dose, filter lifespan, duration of ICU stay, survival rates at 28/90 days and adverse reactions were evaluated. Results: Effective daily delivered CRRT doses in group A \[(27.7±0.98) mL/（kg•h)\] were significantly lower than in group B \[(28.8±1.91)mL/(kg•h), P<0.05\]. Filter lifespan in group B was significantly longer than that in group A \[(44.4±7.63)h vs (27.3±9.69)h,P<0.01\]. Survival rates at 28/90 days in group B were higher than in group A, duration of ICU stay in group B were shorter than that in group A, but the difference was not statistically significant (P>0.05). Group A had 2 cases of gastrointestinal bleeding, and no adverse reactions occurred in group B. Conclusions: Citrate anticoagulant may be better than LMWH for CRRT in critical patients with AKI. Citrate anticoagulant may have higher effective daily delivered CRRT dose and longer filter lifespan, and no adverse reactions were found.