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高危出血倾向患者血液透析中局部枸橼酸抗凝的应用 预览

Application of local anticoagulation with citrate in hemodialysis of patients with high risk of bleeding tendency
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摘要 目的探究在高危出血倾向患者血液透析过程中采取局部枸橼酸抗凝的应用效果。方法回顾性选取2016年1月至2019年1月于上海市第八人民医院进行血液透析治疗的具有高危出血倾向的120例患者作为研究对象,采取隔日枸橼酸局部抗凝的方式,观察患者在每次透析之前,进行透析2 h和透析结束时动脉端血检测相关指标,电解质和酸碱度指标包括血钠、血钾、血氯、总钙、游离钙、p H值,肾功能和凝血功能指标包括血肌酐、尿素氮以及通过检测透析2 h末端钙离子浓度所确定的激活凝血时间(ACT)水平。分析两组患者透析器中凝血程度、静脉壶凝血情况以及不良反应发生情况。结果在透析2 h以及透析结束之后,均发现有血钾的明显降低(t=5. 215、9. 437,P <0. 05),而血钠、血氯、总钙、游离钙、p H值与透析之前比较,差异并无统计学意义(P> 0. 05);透析2 h以及透析结束时,患者的血肌酐和尿素氮水平均发生了明显的降低(血肌酐对应分别为t=8. 125、13. 065,尿素氮对应分别为t=10. 231、12. 714,P<0. 05),而ACT水平无明显变化(P> 0. 05);透析结束后,透析器凝血0~1级的比率明显升高为90. 22%,2级明显降低到7%,3级明显降低到2. 8%,静脉壶出现明显凝血的比率降为3. 07%,少许凝血的比率降为10. 06%,相比透析前均有明显的变化(χ~2=23. 081、13. 151、15. 469、14. 214、17. 583,P <0. 05);透析结束后,患者没有发生出血或者原有出血情况加重的现象,5例患者出现全身抽搐,7例患者出现肌肉痉挛,10例患者出现口唇周围发麻,不良反应发生率为18.33%(22/120)。结论对于具有高危出血倾向的患者在血液透析过程中采取局部枸橼酸抗凝的方式抗凝效果较佳,疗效显著,安全性较高,值得临床借鉴。 Objective To explore the effect of application with citrate anticoagulation during hemodialysis in patients with high-risk bleeding tendency in Shanghai No. 8 Hospital for hemodialysis during January 2016 to January 2019 were retrospectively selected as study subjects.Methods The topical anticoagulation was performed every other day,and. these patients were observed before each dialysis,after 2 h-dialysis and at the end of arterial blood and related indicators,electrolytes and pH indicators including blood levels of sodium,potassium,chlorine,total calcium,free calcium,pH,renal function and coagulation parameters including serum creatinine,urea nitrogen and the level of ACT were determined by measuring the concentration of calcium ion concentration at the end of 2 h dialysis. The degree of coagulation in the dialysis of patients,the coagulation of venous pot,and the occurrence of clinical adverse reactions were analyzed. Results After 2 h of dialysis and at the end of dialysis,the serum level of potassium was significantly decreased( t = 5. 215,9. 437,P < 0. 05),while blood levels of chlorine,total calcium,free calcium,and pH were not significantly different between these two groups( P > 0. 05) in comparison with those before dialysis. At the end of dialysis,the serum levels of creatinine and urea nitrogen were significantly decreased( the serum creatinine was t = 8. 125,13. 065. urea nitrogen was t = 10. 231,12. 714,respectively,P < 0. 05),but there was no significant change in ACT( P > 0. 05). After dialysis,the proportion of phage 0-1 was significantly increased to 90. 22%,and level 2 was significantly reduced to 7%. Level 3 was significantly reduced to 2. 8%,and the proportion of obvious coagulation in the intravenous jug was decreased to 3. 07%,and the proportion of coagulation decreased to 10. 06%,which was significantly different from that before dialysis(χ~2= 23. 081,13. 151,15. 469,14. 214,17. 583 P < 0. 05). After dialysis,patients did not have bleeding or the original bleeding was not aggravated,5 pati
作者 黄艳玲 陈永华 袁利 汪年松 HUANG Yan-ling;CHEN Yong-hua;YUAN Li(Department of Nephology,Shanghai No.8 Hospital,Shanghai 200235,China.)
出处 《临床和实验医学杂志》 2019年第18期2002-2005,共4页 Journal of Clinical and Experimental Medicine
基金 上海市卫生和计划生育委员会课题(编号:201640173).
关键词 高危出血倾向 血液透析 局部抗凝 枸橼酸 High risk bleeding tendency Hemodialysis Local anticoagulation Niacin
作者简介 通讯作者:黄艳玲,E-mail: hyl82917@163.com.
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