2023 年第 9 期 第 18 卷

局部枸橼酸钠联合低分子肝素治疗在行连续性肾脏替代治疗危重症患者中的抗凝效果

Anticoagulant effect of local sodium citrate combined with low molecular weight heparin in critically ill patients undergoing continuous renal replacement therapy

作者：张毅1姜艳艳2敖华3崔凯1

英文作者：Zhang Yi1 Jiang Yanyan2 Ao Hua3 Cui Kai1

单位：1三峡大学第三临床医学院国药葛洲坝中心医院重症医学科，宜昌443002；2三峡大学第三临床医学院国药葛洲坝中心医院护理部，宜昌443002；3三峡大学第三临床医学院国药葛洲坝中心医院肾内科，宜昌443002

英文单位：1Department of Critical Care Medicine the Third Clinical Medical College of China Three Gorges University Gezhouba Central Hospital of Sinopharm Yichang 443002 China; 2Nursing Department the Third Clinical Medical College of China Three Gorges University Gezhouba Central Hospital of Sinopharm Yichang 443002 China; 3Department of Nephrology the Third Clinical Medical College of China Three Gorges University Gezhouba Central Hospital of Sinopharm Yichang 443002 China

关键词：连续性肾脏替代治疗；危重症；电解质；血滤器使用寿命

英文关键词：Continuousrenalreplacementtherapy;Criticallyill;Electrolyte;Filterservicelife

• 摘要：

• 目的  探索局部枸橼酸钠联合低分子肝素治疗对行连续性肾脏替代治疗（CRRT）危重症患者抗凝效果的影响。方法 前瞻性选取2018年4月至2021年4月国药葛洲坝中心医院收治的80例行CRRT危重症患者作为研究对象，根据随机数字表法分为观察组（41例）和对照组（39例）。对照组采用局部枸橼酸钠抗凝，观察组采用局部枸橼酸钠联合低分子肝素抗凝。比较2组治疗前后凝血功能指标、血清电解质、pH值、血常规指标以及抗凝有效性和血滤器使用寿命。结果 治疗后24 h，2组活化部分凝血活酶时间、凝血酶时间、凝血酶原时间均长于治疗前，且观察组均长于对照组［（51.7±4.7）s比（43.3±2.2）s、（18.96±1.24）s比（17.86±0.31）s、（20.5±2.6）s比（18.2±2.2）s］（均P＜0.05）；2组血清氯离子、钙离子、钠离子、钾离子水平均低于治疗前，且观察组均低于对照组（均P＜0.05）；2组血小板计数、血红蛋白、白细胞计数均低于治疗前（均P＜0.05），但组间比较差异均无统计学意义（均P＞0.05）。治疗后24 h，观察组抗凝有效性0级比例高于对照组，Ⅱ、Ⅲ级比例均低于对照组（均P＜0.05）。观察组血滤器使用寿命长于对照组［（30±3）h比（28±4）h］，但组间比较差异无统计学意义（t=1.918，P=0.059）。结论 局部枸橼酸钠联合低分子肝素用于行CRRT危重症患者中，能够延长血滤器使用寿命，维持机体电解质平衡。

• Objective To explore the anticoagulant effect of local sodium citrate combined with low molecular weight heparin in critically ill patients undergoing continuous renal replacement therapy (CRRT). Methods From April 2018 to April 2021, 80 critically ill patients with CRRT were prospectively selected as research subjects from Gezhouba Central Hospital of Sinopharm. They were divided into observation group (41 cases) and control group (39 cases) according to the random number table method. The control group was treated with local sodium citrate for anticoagulation, and the observation group was treated with local sodium citrate combined with low molecular weight heparin for anticoagulation. The coagulation function index, serum electrolyte, pH value, blood routine index before and after treatment, as well as anticoagulation efficacy and filter service life were compared between the two groups. Results Activated partial thromboplastin time, thrombin time and prothrombin time in the two groups 24 h after treatment were longer than those before treatment, and those in the observation group were longer than those in the control group［（51.7±4.7）s vs （43.3±2.2）s,（18.96±1.24）s vs （17.86±0.31）s,（20.5±2.6）s vs （18.2±2.2）s］(all P<0.05). Serum levels of chloride ion, calcium ion, sodium ion and kalium ion in the two groups were lower than those before treatment, and those in the observation group were lower than those in the control group (all P<0.05). Levels of platelet count, hemoglobin and white blood cell count in the two groups were lower than those before treatment(all P<0.05), while there were no significant differences between groups (all P>0.05). The proportion of grade 0 of anticoagulation efficacy 24 h after treatment in the observation group was higher than that in the control group, and the proportions of grade Ⅱ and grade Ⅲ in the observation group were lower than those in the control group (all P<0.05). The filter service life in the observation group was longer than that in the control group［（30±3）h vs （28±4）h］, while there was no significant difference between groups (t=1.918, P=0.059). Conclusions  The application of local sodium citrate combined with low molecular weight heparin in critically ill patients undergoing CRRT can prolong the filter service life and maintain the electrolyte balance of the body.