摘要
目的探讨局部枸橼酸抗凝在血浆置换及序贯连续性血液透析滤过治疗中的有效性及安全性。方法回顾性选择2021年9月—2022年8月聊城市人民医院肾内科住院需行血液净化并存在出血或出血倾向的患者共13例为研究对象,接受局部枸橼酸抗凝单重血浆置换及序贯连续性血液透析滤过共59例次。回顾性分析患者的临床资料,包括治疗中内环境变化、药物用量调整、治疗前后机体凝血功能变化和体外循环凝血情况,以及治疗期间不良反应等。结果13例患者共行血浆置换59例次,其中序贯连续性血液透析滤过治疗26例次。血浆置换液均应用新鲜冰冻血浆,所有例次血浆置换抗凝效果良好,抗凝有效率为100%。序贯连续性血液透析滤过治疗抗凝有效率为80.77%(21/26)。治疗过程中患者生命体征平稳,没有严重并发症发生。治疗前后患者的凝血功能无明显变化,均未出现出血或出血倾向加重。血浆置换治疗结束后出现血pH、血钠及碳酸氢根水平升高,其中血pH在血浆置换结束后达7.50,较治疗前差异有统计学意义(t=-6.821,P<0.05)。结论局部枸橼酸抗凝效果理想,对于需行血液净化并存在出血情况或出血倾向的患者安全性高。治疗过程注意监测血pH、血离子钙及碳酸氢根水平,在杂合血液净化模式衔接期需加强监测,及时调整药物用量,避免严重内环境紊乱。
Objective To investigate the efficacy and safety of regional citrate anticoagulated in plasma exchange and sequential hemodiafiltration.Methods A total of 13 patients who were hospitalized in the Department of Nephrology of Liaocheng People's Hospital from September 2021 to August 2022 and needed blood purification and had bleeding or bleeding tendency were retrospectively selected as the study subjects.A total of 59 patients received regional citrate anticoagulated single double plasma exchange and sequential hemodiafiltration.Clinical data of the patients were retrospectively analyzed,including changes of internal environment during treatment,adjustment of drug dosage,changes of blood coagulation function before and after treatment,blood coagulation during extracorporeal circulation,and adverse reactions during treatment.Results A total of 59 cases of plasma exchange were performed in 13 patients,of which 26 cases were treated with sequential continuous hemodiafiltration.Fresh frozen plasma was used in the plasma exchange solution.The anticoagulant effect was good in all cases,and the anticoagulant effective rate was 100%.The anticoagulation rate of sequential hemodiafiltration was 80.77%(21/26).The patient's vital signs were stable and no serious complications occurred during the treatment.There was no significant change in the coagulation function of the patients before and after treatment,and no bleeding or bleeding tendency was aggravated.Serum pH,sodium and bicarbonate levels increased after plasma exchange,and the serum pH reached 7.50 after plasma exchange,which was statistically significant compared with that before treatment,and the difference was statistically significant(t=-6.821,P<0.001).Conclusion The anticoagulant effect of regional citrate anticoagulated is ideal,and it is safe for patients who need blood purification and have bleeding condition or bleeding tendency.Blood pH,blood ionic calcium and bicarbonate levels should be monitored during treatment.During the transition period of heterozygou
作者
洪虹
范明坤
王梦君
李捷
HONG Hong;FAN Mingkun;WANG Mengjun;LI Jie(Department of Nephrology,Liaocheng People's Hospital,Liaocheng,Shandong Province,252000 China)
出处
《中外医疗》
2023年第26期25-29,共5页
China & Foreign Medical Treatment
基金
山东省医药卫生科技发展计划项目(202103050595)。
关键词
局部枸橼酸抗凝
血浆置换
连续性血液透析滤过
Regional citrate anticoagulated
Plasma exchange
Continuous hemodiafiltration
