發(fā)布時間：2018-08-01 12:00

【摘要】：目的:觀察無肝素透析時采用簡化枸櫞酸抗凝方案進(jìn)行抗凝的有效性及安全性。方法:選擇2016年6月-2017年1月在我科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人,采用簡化方式進(jìn)行枸櫞酸抗凝:前期采用方案一進(jìn)行抗凝,即使用15%枸櫞酸三鈉(TSC)在濾器前以40ml/h的速度持續(xù)輸入;后期患者采用方案二進(jìn)行抗凝,即在前者基礎(chǔ)上同時在靜脈壺以l0ml/h的速度輸入15%TSC。兩種方案都不另外補(bǔ)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?dú)?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:簡化枸櫞酸抗凝方式能保證多數(shù)無肝素透析治療的順利進(jìn)行,避免濾器、靜脈壺嚴(yán)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?dú)饨Y(jié)果無明顯影響。
[Abstract]:Objective: to observe the efficacy and safety of simplified citric acid anticoagulant regimen in non-heparin dialysis. Methods: 42 patients were treated with maintenance hemodialysis in our department from June 2016 to January 2017. 42 patients were treated without heparin dialysis for various reasons. Even though 15% trisodium citrate (TSC) was continuously injected in front of the filter at the speed of 40ml/h, in the later stage the patients were treated with anticoagulant, that is, on the basis of the former, 15 TSCs were injected at the speed of l0ml/h at the same time in the jug of vein. Neither option is supplemented with calcium. To observe the anticoagulant effect, duration of single dialysis and possible adverse reactions. Results Thirteen patients were treated with one anticoagulant, a total of 37 patients with hemodialysis were treated with anticoagulant, 29 patients with hemodialysis were treated with the second anticoagulant, and 129 patients were dialyzed. No adverse reaction was found in all the treatments. The proportion of patients who completed the scheduled 3-4 h dialysis treatment was 75.775% in the first scheme and 98.4% (p0.01) in the second scheme. The anticoagulant efficiency of the filter and the blood below the middle of the jug was considered to be effective. The effective rate of the filter was 89.12% (P 0.05) and 90.7% (p0.05), respectively, and that of the venous jug was 90.7% (p0.05). The anticoagulant efficiency of the filter was 94.57% (P 0.05), and that of the venous jug was 78.3% (p0.05). The results of monitoring blood gas before and after dialysis showed that there was no significant difference in the level of ion calcium between before and after dialysis (p0.05). Conclusion: the simplified anticoagulant method of citric acid can ensure the smooth progress of most hemodialysis without heparin, and avoid the filter, the severe coagulation of the venous jug and the early termination of dialysis, especially in the second scheme, the incidence of coagulation in the venous pot is obviously decreased. There was no obvious adverse effect on blood gas.
【學(xué)位授予單位】：南京大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R692.5
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本文編號：2157508