持续性肾脏替代治疗两种抗凝方法的比较及护理体会

目的通过回顾性分析83例急性肾损伤危重患者应用局部枸橼酸盐或者低分子肝素抗凝进行连续性肾脏替代治疗(continuous renal replacement therapy,CRRT),探讨不同抗凝方式的抗凝效果并浅谈护理体会。方法将患者按照不同的抗凝方案分为枸橼酸盐组(53例)和低分子肝素组(30例)。对两组枸橼酸泵前活化部分凝血活酶时间、血液透析器后血液滤过管路游离钙、钙泵后动脉游离钙、透析器使用时间和患者治疗过程中出血事件等指标进行统计学比较。结果枸橼酸盐组血液透析器使用时间明显长于低分子肝素组,分别为(72±8)h和(48±9)h,差异有统计学意义(P0.05);而出血事件发生率明显低于低分子抗凝组,分别为7.55%和40.00%,差异有统计学意义(P0.05)。结论局部枸橼酸盐可广泛应用于各种危重症患者CRRT的抗凝治疗,在延长血液透析器使用时间、减少出血等方面具有明显优势。

Comparison of the two anticoagulation methods in continuous renal replacement therapy and the related nursing experiences

Objective This retrospective study evaluated the efficacy of regional citrate anticoagulation （RCA） and low molecular heparin anticoagulation （LMH） methods,and introduced the related nursing experiences. Methods A total of 83 acute kidney injury （AKI） patients treated with continuous renal replacement therapy （CRRT） were studied retrospectively. Variables related to anticoagulation therapy were collected and compared between the patients using RCA and those using LMH. Results The lifetime of hemofilter was longer using RCA method （72±8h） then using LMH method （48±9h） （P0.05）. Hemorrhage accidents were statistically lower in RCA patients （4 cases,7.55%） than in LMH patients （12 cases,40.00%; P0.05）. Conclusion Regional citrate anticoagulation is a safer and more effective anticoagulation method for CRRT patients,which can be recommended for clinical use.