不同抗凝方式的连续性肾脏替代疗法在创伤性凝血病合并急性呼吸窘迫综合征患者中的应用效果比较被引量：6

Application efficacy of continuous renal replacement therapy with different anticoagulation methods in patients with traumatic coagulopathy complicated with acute respiratory distress syndrome:a comparative study

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摘要目的比较不同抗凝方式的连续性肾脏替代疗法(CRRT)治疗创伤性凝血病合并急性呼吸窘迫综合征(ARDS)患者的临床效果及安全性。方法将167例创伤性凝血病合并ARDS患者随机分为无抗凝组55例、低分子量肝素组56例、枸橼酸组56例。所有患者均接受创伤和ARDS相关治疗,在此基础上,无抗凝组患者行无抗凝处理的CRRT治疗,低分子量肝素组患者行低分子量肝素钠抗凝处理的CRRT治疗,枸橼酸组患者行枸橼酸钠抗凝处理的CRRT治疗。比较3组患者治疗前和CRRT治疗后24 h、48 h、72 h的氧合指数和凝血功能,治疗前和治疗后第3天、第7天、第10天的急性和慢性健康状况评估量表Ⅱ(APACHEⅡ)评分,以及机械通气时间、入院14 d病死率、滤器使用寿命、并发出血情况、血滤器抗凝有效性。结果与低分子量肝素组、无抗凝组比较,在CRRT治疗后各时间点,枸橼酸组的D-二聚体更低、活化部分凝血酶原时间和凝血酶原时间更短,纤维蛋白原水平和氧合指数更高,APACHEⅡ评分更低(均P<0.05)。枸橼酸组的滤器使用寿命优于其他两组,抗凝有效性优于无抗凝组,机械通气时间短于其他两组,且并发出血率低于低分子量肝素组(P<0.05)。但3组患者入院14 d病死率差异无统计学意义(P>0.05)。结论对于使用CRRT治疗的创伤性凝血病合并ARDS患者,与应用低分子量肝素抗凝及无抗凝相比,应用枸橼酸抗凝在提高氧合、改善凝血功能、降低出血风险方面的作用更显著。 Objective To compared the clinical efficacy and safety between continuous renal replacement therapy(CRRT)with different anticoagulation methods for patients with traumatic coagulopathy complicated with acute respiratory distress syndrome(ARDS).Methods A total of 167 patients with traumatic coagulopathy complicated with ARDS were randomly divided into non-anticoagulation group(n=55),low-molecular-weight heparin group(n=56)and citric acid group(n=56).All patients received symptomatic treatment associated with trauma and ARDS,based on which patients in the non-anticoagulation group received CRRT without anticoagulation treatment,patients in the low-molecular-weight heparin group received CRRT with anticoagulation treatment with low-molecular-weight heparin sodium,and patients in the citric acid group received CCRT with anticoagulation treatment with sodium citrate.The relevant indices were compared among the three groups,including oxygenation index and coagulation function before treatment and 24,48 and 72 hours after CCRT,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)scores before treatment and on the 3rd,7th and 10th day after treatment,as well as duration of mechanical ventilation,fatality rate on day 14 of admission,service life of filters,incidence of concomitant bleeding,and anticoagulant effectiveness of blood filters.Results Compared with the low-molecular-weight heparin group or non-anticoagulation group,at each time point after CRRT,the citric acid group exhibited lower D-dimer,shorter activated partial thromboplastin time and prothrombin time,higher fibrinogen level and oxygenation index,and lower APACHEⅡscore(all P<0.05).The citric acid group was superior to the other two groups in service life of filters,exhibited superior anticoagulant effectiveness over the non-anticoagulation group,reported shorter duration of mechanical ventilation than the other two group,and presented a lower rate of concomitant bleeding than the low-molecular-weight heparin group(P<0.05).However,there was no stati

作者易亚辉谭曦舒易辉宾卫星徐燕 YI Ya-hui;TAN Xi-shu;YI Hui;BIN Wei-xing;XU Yan(Department of Critical Care Medicine,Zhuzhou People′s Hospital Affiliated to Changsha Medical College,Zhuzhou 412000,China)

机构地区长沙医学院附属株洲市人民医院重症医学科

出处《广西医学》 CAS 2021年第11期1285-1290,共6页 Guangxi Medical Journal

基金湖南省自然科学基金(2017JJ4063)。

关键词创伤性凝血病急性呼吸窘迫综合征连续性肾脏替代疗法低分子量肝素钠枸橼酸钠抗凝临床效果安全性 Traumatic coagulopathy Acute respiratory distress syndrome Continuous renal replacement therapy Low-molecular-weight heparin sodium Sodium citrate Anticoagulation Clinical effect Safety

分类号 R641 [医药卫生—外科学]