改良枸橼酸钠输注法在连续性血液净化患者中的应用

doi:10.3761/j.issn.0254-1769.2020.12.016

摘要/Abstract

摘要：

目的观察局部枸橼酸钠不同输注方式对连续性血液净化患者体外循环通路抗凝效果的影响。方法选取2018年1月—12月行连续性血液净化治疗的40例患者为研究对象,随机分为试验组和对照组。试验组实施改良的枸橼酸钠输注法,即在动脉端和静脉气泡捕获器（滴口室）同时泵入4%枸橼酸钠溶液;对照组实施常规的枸橼酸钠输注法,即将4%枸橼酸钠溶液全部从动脉端泵入。试验组动脉端和静脉气泡捕获器的泵速之和与对照组相同。分别比较两组治疗48 h滤器及滴口室凝血情况,在滴口室出现Ⅲ级凝血时终止监测,并检测外周游离钙、滤器后游离钙和外周碳酸氢根值及体外循环通路使用寿命。结果治疗48 h试验组滴口室Ⅱ级凝血比率是10.0%,对照组为40.0%,差异有统计学意义（Z=2.157,P=0.031）;试验组体外循环通路使用寿命为（96.78±17.49） h,明显高于对照组的（65.50±13.63） h,差异有统计学意义（t=12.204,P=0.001）。两组体外循环通路滤器凝血级别和治疗中外周游离钙的比较,差异均无统计学意义（P>0.05）。结论改良枸橼酸钠输注法是安全、有效的连续性血液净化抗凝方式,可以降低滴口室凝血的风险,延长体外循环通路使用寿命。

关键词: 肾替代疗法, 血液滤过, 枸橼酸抗凝, 滴口室, 血液凝固, 护理

Abstract:

Objective The aim of this study is to compare the anticoagulant effects of different citrate infusion methods in treatment with continuous blood purification（CBP）. Methods From January to December 2018,40 patients with CBP were recruited randomly from Intensive Care Unit of the Affiliated Hospital of Qingdao University. These patients were randomly allocated into 2 groups according to the different infusion methods of citrate. In the control group,patients（n=20） were treated with a simplified infusion method,and all 4% citrate solution was infused into the artery of the single needle double lumen tube. In the observation group,patients（n=20） were treated with the improved citrate infusion method. Briefly,4% sodium citrate solution was infused into the artery and venous chamber,respectively. The sum of 2 pumping speeds was the same as that in the control group. The coagulation levels of filters and venous chambers in 2 groups after 48 hour were compared respectively. The monitoring was terminated when the level Ⅲ coagulation presented in venous chambers. The peripheral calcium,filtered calcium,bicarbonate value and the service life of cardiopulmonary bypass were measured. Results After 48 hours,40% of venous chambers in the control group presented level Ⅱ coagulation,which was significantly higher than 10% in the observation group（P=0.031） with none of tube presenting level Ⅲ coagulation. The average service time of cardiopulmonary bypass in the observation group was（96.78±17.49） h,which was significantly higher than（65.50±13.63） h in the control group,and the differences were statistically significant（t=12.204,P=0.001）. There was no statistically significant difference in coagulation status and blood calcium value between 2 groups（P>0.05）. Conclusion The modified regional citrate infusion is a safe,feasible,and effective method for the treatment of CBP.

Key words: Renal Replacement Therapy, Hemofiltration, Citrate Anticoagulation, Venous Chamber, Blood Coagulation, Nursing Care

卢亮,周娜,徐玉,王奉涛,李笑稚,申艳玲. 改良枸橼酸钠输注法在连续性血液净化患者中的应用[J]. 中华护理杂志, 2020, 55(12): 1850-1854.

LU Liang,ZHOU Na,XU Yu,WANG Fengtao,LI Xiaozhi,SHEN Yanling. Application of modified citrate infusion method for patients under continuous renal replacement therapy[J]. Chinese Journal of Nursing, 2020, 55(12): 1850-1854.

图/表 5

图1 试验组枸橼酸钠输注方式示意图

Figure 1 Schematic diagram of sodium citrate infusion method in the observation group

图2 对照组枸橼酸钠输注方式示意图

Figure 2 Schematic diagram of sodium citrate infusion method in the control group

表1 两组一般资料的比较($\bar{x}\pm s$)

Table 1 Comparison of general data between 2 groups($\bar{x}\pm s$ )

Table 2 Comparison of 48 -hour coagulation between extracorporeal circulation filters and dropping chamber between 2 groups [ cases ( percentage,%) ]

表3 两组滤器后游离钙浓度、外周血游离钙浓度、外周血碳酸氢根浓度比较(mmol/L, $\bar{x}\pm s$)

Table 3 Comparison of the peripheral calcium , filtered calcium,bicarbonate value between 2 groups ( mmol/L, $\bar{x}\pm s$)

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