内科理论与实践

内科理论与实践 ›› 2023, Vol. 18 ›› Issue (05): 322-327.doi: 10.16138/j.1673-6087.2023.05.003

• 论著 • 上一篇    下一篇

普通含钙透析液分段枸橼酸抗凝与无肝素透析在高危出血透析患者中的应用

张瑜, 王志宏, 董毳, 郐婷婷, 由莲莲, 刘书馨()   

  1. 大连市中心医院肾内科 大连市智慧血液净化重点实验室，辽宁 大连 116033
  • 收稿日期:2023-02-21 出版日期:2023-10-30 发布日期:2024-01-25
  • 通讯作者: 刘书馨 E-mail:root8848@sina.com
  • 基金资助:
    大连市医学重点专科“登峰计划”项目(2022ZZ232);大连市医学重点专科“登峰计划”项目(2022ZZ247)

Comparison of ordinary calcium-containing dialysate segmented regional citrate anticoagulation hemodialysis and heparin-free hemodialysis in patients with high risk of bleeding

ZHANG Yu, WANG Zhihong, DONG Cui, KUAI Tingting, YOU Lianlian, LIU Shuxin()   

  1. Department of Nephrology, Dalian Key Laboratory of Intelligent Blood Purification, Dalian Municipal Central Hospital, Dalian 116033, China
  • Received:2023-02-21 Online:2023-10-30 Published:2024-01-25
  • Contact: LIU Shuxin E-mail:root8848@sina.com

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摘要： 目的 观察应用普通含钙透析液分段局部枸橼酸抗凝（regional citrate anticoagulation，RCA）的安全性、有效性。与无肝素透析比较在高危出血患者中凝血情况、治疗时间的差异。方法 选取大连市中心医院2019年1月至2021年12月有高危出血风险的维持性血液透析患者35例，其中男性19例，女性16例。分别予以无肝素透析和4%枸橼酸钠局部抗凝治疗，枸橼酸应用输液泵分别自管路动脉端和静脉壶处持续泵入。比较RCA应用前后患者血离子情况、血压变化和出凝血时间影响。比较2种方法凝血情况、透析时间的差异。结果 枸橼酸组患者通过在线调整透析机参数，透析后血钠可以维持平稳（P>0.05）。应用含钙透析液（1.5 mmol/L），无低钙血症发生，透析后血钙较透析前升高（P<0.05）。枸橼酸组患者透析前后血压、心率平稳，无明显变化（P>0.05），随着透析时间延长，静脉压、跨膜压有所升高（P<0.05）。RCA治疗后患者活化部分凝血活酶时间（activated partial thromboplastin time，APTT）较透析前延长（P<0.05），余出凝血时间较透析前差异无统计学意义（P>0.05）。枸橼酸组透析器及静脉壶抗凝有效性明显高于无肝素组（P<0.05），超滤量高于无肝素组（P<0.05），实际透析时间长于无肝素组（P<0.001），尿素清除指数（Kt/V）高于无肝素组（P<0.001）。结论 普通含钙透析液RCA应用于高危出血风险透析患者安全、有效。抗凝效果好，优于无肝素透析。

关键词: 局部枸橼酸抗凝, 无肝素透析, 含钙透析液, 终末期肾病

Abstract: Objective To investigate the safety and efficacy of regional citrate anticoagulation (RCA) with ordinary calcium-containing dialysate in hemodialysis, and compare its differences in coagulation status and treatment time with heparin-free hemodialysis in high-risk bleeding patients. Methods Maintenance hemodialysis patients with high risk of bleeding from Dalian Municipal Central Hospital from January in 2019 to December in 2021 were selected, a total of 35 patients were enrolled (19 males and 16 females), and they received heparin-free hemodialysis or 4% sodium regional citrate anticoagulation treated hemodialysis. Citrate was infused into the arterial line and vein line through the dialyzer. The electrolyte, blood pressure, and coagulation system in hemodialysis patient were compared before and after the application of segmented citrate anticoagulation. The differences of coagulation and treatment time between the two methods were compared. Results In the citrate treated group, through adjusting the parameters of the dialysis machine online, the serum sodium could be kept stable after dialysis(P>0.05). Hypocalcemia didn’t occur in the application of calcium-containing dialysate (1.5 mmol/L), while serum calcium increased after dialysis (P<0.05). The blood pressure and heart rate of the patients in the citrate treated group were stable before and after dialysis(P>0.05). Activated partial thromboplastin time (APTT) of patients after local citrate anticoagulation was prolonged compared with that before dialysis(P<0.05), and the remaining coagulation time was not significantly different from that before dialysis (P>0.05). In the citrate treated group, the anticoagulation efficacy of the dialyzer and venous pot (P<0.05), ultrafiltration volume (P<0.05) and urea clearance index(Kt/V)(P<0.001) were significantly higher than those in the non-heparin group, while the actual dialysis time was longer than that in the non-heparin group (P<0.001). Conclusions The segmented regional citrate anticoagulation of ordinary calcium-containing dialysate is safe and effective in high-risk bleeding risk dialysis patients, and its anticoagulant effect is better than that in heparin-free hemodialysis.

Key words: Regional citrate anticoagulation, Heparin-free hemodialysis, Calcium-containing dialysate, End-stage renal disease

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