發(fā)布時間：2018-03-28 18:05

  本文選題：維持性血液透析　切入點：凝血　出處：《腎臟病與透析腎移植雜志》2017年04期

【摘要】：目的:觀察無肝素透析時采用簡化枸櫞酸抗凝(RCA)方案進行抗凝的有效性及安全性。方法:選擇2016年6月~2017年1月在南京總醫(yī)院國家腎臟疾病臨床醫(yī)學(xué)研究中心行維持性血液透析治療、因各種原因需行無肝素透析患者共42例,采用簡化RCA方案抗凝,前期患者采用方案一,后期患者采用方案二,兩種方案都不另外補充鈣劑。觀察抗凝效果、單次透析持續(xù)時間及可能出現(xiàn)的不良反應(yīng)。結(jié)果:13例患者采用方案一抗凝,共完成37例次透析,29例患者采用方案二抗凝,共完成129例次透析,所有治療均未發(fā)生不良反應(yīng)。完成預(yù)定3~4h透析治療的比例:方案一為75.7%,方案二為98.4%(P0.01)。將濾器及靜脈壺中度以下凝血視為抗凝有效,方案一及方案二的濾器抗凝有效率分別為89.12%、94.57%(P0.05),而靜脈壺抗凝有效率分別為78.3%、90.7%(P0.05)。方案二患者監(jiān)測透析前后血氣,結(jié)果顯示透析后離子鈣水平與透析前無顯著性差異(P0.05)。結(jié)論:簡化RCA方案能保證多數(shù)患者無肝素透析治療順利進行,避免濾器、靜脈壺嚴重凝血及其導(dǎo)致的透析提前中止,特別是方案二,靜脈壺凝血的發(fā)生率明顯下降,并且未發(fā)生明顯不良反應(yīng),對血氣結(jié)果無明顯影響。
[Abstract]:Objective: to observe the efficacy and safety of simplified citrate anticoagulant (RCA) regimen in hemodialysis without heparin. Methods: from June 2016 to January 2017, we selected the National Renal Disease Clinical Medical Research Center of Nanjing General Hospital. Maintenance hemodialysis, A total of 42 patients with non-heparin dialysis were treated with simplified RCA regimen for various reasons. The patients were treated with regimen one in the early stage and the patients in the later stage with the second regimen. Neither regimen was supplemented with calcium separately. The anticoagulant effect was observed. Results Thirteen patients with single dialysis were treated with one anticoagulant, 29 patients with 37 hemodialysis patients were treated with the second anticoagulant, and 129 patients with hemodialysis. There were no adverse reactions in all the treatments. The proportion of hemodialysis therapy scheduled for 34 h was 75.7 for scheme one and 98.4 for P0.01 for scheme two. The coagulation of filter and venous jug was regarded as anticoagulant. The anticoagulant effective rates of the filters in the first and second schemes were 89.12 and 94.57, respectively, and the anticoagulant efficiency of the venous jugs were 78.3 and 90.7, respectively. The blood gas of the patients before and after dialysis was monitored. The results showed that there was no significant difference in ion calcium level after dialysis compared with that before dialysis. Conclusion: the simplified RCA regimen can ensure the successful treatment without heparin in most patients, and avoid the filter, venous coagulation and the early termination of dialysis. In the second scheme, the incidence of venous coagulation decreased significantly, and no significant adverse reactions occurred, which had no significant effect on the blood gas results.
【作者單位】： 南京大學(xué)醫(yī)學(xué)院附屬金陵醫(yī)院(南京總醫(yī)院)腎臟科;南京大學(xué)醫(yī)學(xué)院附屬金陵醫(yī)院(南京總醫(yī)院)腎臟科國家腎臟疾病臨床醫(yī)學(xué)研究中心全軍腎臟病研究所;
【基金】：國家自然科學(xué)基金面上項目(81170708) 國家重點研發(fā)計劃課題(2016YFC0904103)
【分類號】：R692.5

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