体外枸橼酸抗凝在不同血液净化方式中的应用效果及其安全性分析

目的 观察体外枸橼酸抗凝技术在不同血液净化方式中的应用效果及其安全性。方法 46例伴有出血倾向患者行血液净化治疗，采用枸橼酸体外抗凝共86例次，根据病情需要分别行血液透析(HD)、透析滤过(HDF)及连续性静脉至静脉血液滤过(CVVH)。监测治疗中活化凝血时间(ACT)、血清离子钙、血钠、二氧化碳结合力的变化、体外循环部分的抗凝效果和有无出血加重的情况。结果 所有患者治疗中体外循环的ACT较治疗前ACT显著延长，治疗后ACT较治疗前ACT无显著变化。HD方式的透析器平均复用5．86次，HDF方式的透析器平均复用5．6次。CVVH连续8小时无凝血情况。无1例出血加重，无枸橼酸引起的高钠及代谢性酸中毒。结论 枸橼酸体外抗凝在HD、HDF和CVVH三种血液净化方式中有良好的体外抗凝效果，不加重患者的出血倾向，无高钠及碱中毒。为当前高危出血患者最佳抗凝方式。

Effect and safety of extracorporeal citrate anticoagulation protocol in various methods of blood purification

Objectives To observe the effect and safety of extracorporeal citrate anticoagulation protocol in various methods of blood purification.Methods Forty-six patients at high risk of bleeding were involved in our study.Extracorporeal citrate anticoagulation was performed in these patients for 86 times,who received hemodialysis (HD),hemodiafiltration (HDF) or continuous venovenous hemofiltration (CVVH) due to the severity of the illnesses.Activated clotting time (ACT),serum ionized calcium and sodium,and carbon dioxide combining power were monitored during the treatments.We also evaluated the anticoagulation effect in the extracorporeal circuit and the risk of bleeding.Results Of all the patients,there were obvious prolongations of ACT during blood purification,but ACT were no obvious differences between pretreatment and posttreatment.The mean times of dialyzers reuse for HD was 5.86,and that for HDF was 5.6. As for CVVH,no clotting episodes occurred.There was no increasing risk of bleeding for all patients.Conclusion Extracorporeal citrate anticoagulation is effective in HD,HDF and CVVH,and it does not increase the risk of bleeding,hypernatremia and alkalosis.So it is an optimum technique of anticoagulation in patients at high risk of bleeding.