本文關鍵詞： 枸櫞酸鈉 抗凝治療 血液濾過　出處：《中國老年學雜志》2017年17期 　論文類型：期刊論文

【摘要】：目的探索在心臟大血管手術危重患者血液濾過中使用枸櫞酸鈉抗凝治療的有效性及安全性。方法心胸外科行心臟大血管術后需持續(xù)靜脈血液濾過患者100例,隨機分為局部枸櫞酸鈉抗凝(RCA)組50例和低分子肝素組50例,分別給予枸櫞酸鈉和低分子肝素鈣抗凝治療,比較兩組濾器使用時間,治療前后血清Na~+、Ca~(2+)、實際HCO_3~-、血液pH值的變化及不良反應的發(fā)生次數(shù)。結果 RCA組濾器使用時間[(65.65±9.39)h]明顯長于低分子肝素組[(59.31±9.28)h](P=0.018)。兩組治療前后血清Na~+、Ca~(2+)、實際HCO_3~-、血液pH值均無明顯差異;RCA組未見不良反應。低分子肝素組出現(xiàn)傷口滲血1例,輕度血小板減少2例,輕微牙齦出血2例;但兩組差異不顯著(P0.05)。結論在連續(xù)性血液凈化中RCA較傳統(tǒng)低分子肝素抗凝能保證有效抗凝的同時延長濾器使用時間,減少患者費用,減少出血等不良事件發(fā)生。
[Abstract]:Objective to explore the efficacy and safety of sodium citrate anticoagulant in the treatment of hemofiltration in critically ill patients undergoing cardiac macrovascular surgery. Methods 100 patients with continuous venous hemofiltration after cardiac macrovascular operation were treated by cardiothoracic surgery. 50 cases of local sodium citrate anticoagulant group and 50 cases of low molecular weight heparin group were randomly divided into two groups: sodium citrate group and low molecular weight heparin calcium group. Before and after treatment, the serum Na ~ + Ca ~ (2 +), actual HCO _ 3 +, blood pH value and the occurrence times of adverse reactions were observed. Results the filter time of RCA group [65.65 鹵9.39 h] was significantly longer than that of low-molecular-weight heparin group [59.31 鹵9.28 h] P0.018. There was no significant difference between RCA group and low molecular weight heparin group, but there was no significant difference between RCA group and low molecular weight heparin group. There were 2 cases of mild thrombocytopenia and 2 cases of slight gingival bleeding, but the difference between the two groups was not significant (P 0.05). Conclusion in continuous blood purification, RCA can ensure the effective anticoagulant effect while prolonging the time of filter use and reducing the cost of the patients, compared with the traditional low-molecular-weight heparin anticoagulant. Reduce the occurrence of adverse events such as bleeding.
【作者單位】： 徐州醫(yī)科大學藥學院;南京大學醫(yī)學院附屬鼓樓醫(yī)院藥學部;昭通市第一人民醫(yī)院藥劑科;南京大學醫(yī)學院附屬鼓樓醫(yī)院心胸外科;
【基金】：江蘇省藥學會-奧賽康臨床藥學基金科研項目(No.201401)
【分類號】：R654.2;R692.5

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