【摘要】 目的 探讨局部枸橼酸抗凝(RCA)与全身普通肝素抗凝在重症监护病房(ICU)急性肾损伤(AKI)患者连续性肾脏替代治疗(CRRT)中的安全性及有效性。方法 采用回顾性研究方法。选择2015年12月至2020年12月在新疆维吾尔自治区人民医院重症医学科因AKI接受CRRT的患者作为研究对象,根据抗凝方式不同将患者分为RCA组和全身肝素钠抗凝组,每组40例。收集两组临床资料,包括性别、年龄、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、原发病、血常规、凝血功能、肾肝功能指标及总住院时间、ICU住院时间、滤器使用时间、28 d病死率,比较两组上述指标的差异;绘制Kaplan-Meier生存曲线,分析两组28d累积生存率。结果 血常规和凝血功能指标方面:两组治疗前红细胞计数(RBC)、血红蛋白(Hb)含量、血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)比较差异均无统计学意义。治疗后RBC和Hb均较治疗前明显降低,PT和APTT均较治疗前明显延长;两组治疗后RBC、Hb、PLT、INR比较差异均无统计学意义,但RCA组治疗后PT、APTT均较全身肝素钠抗凝组明显缩短[PT(s):18.46±6.67比20.11±1.05,APTT(s):50.31±10.00比60.55±12.50,均P<0.05]。血生化指标方面:治疗前两组肝肾功能指标比较差异均无统计学意义,治疗后两组血肌酐(SCr)、血尿素氮(BUN)、尿酸(UA)水平均较治前明显降低,但治疗后两组间丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBil)、SCr、BUN、UA、碳酸氢根(HCO-)比较差异均无统计学意义,治疗后全身肝素钠抗凝组血乳酸(Lac)水平较治疗前明显降低,RCA组无明显变化,故治疗后全身肝素钠抗凝组Lac水平较RCA组明显降低(mmol/L:1.07±0.96比2.86±2.49,P<0.05)。两组患者总住院时间、ICU住院时间比较差异均无统计学意义;RCA组治疗后滤器使用时间较全身肝素钠抗凝组明显延长(h:38.72±9.28比21.44±5.62,P<0.05)。Kaplan-Meier生存曲线分析显示,两组28 d累积生存率比较差异无统计学意义(Log-Rank检验:χ~2=1.603,P=0.498)。结论 在ICU接受CRRT的AKI患者,RCA可减少对凝血功能的影响,显著延长滤器的使用时间,临床疗效确切。更多还原

【Abstract】 Objective To investigate the safety and efficacy of regional Citrate anticoagulation(RCA) and systemic unfractionated heparin anticoagulation in continuous renal replacement therapy(CRRT) in patients with acute kidney injury(AKI) in intensive care unit(ICU).Methods A retrospective research method was used.Patients who received CRRT due to AKI in the ICU of People’s Hospital of Xinjiang Uygur Autonomous Region from December 2015 to December 2020 were selected as research subjects.According to different anticoagulation methods,patients were divided into RCA group and systemic heparin sodium anticoagulation group,with 40 cases in each group.The clinical data of the two groups were collected,including gender,age,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ),primary disease,blood routine,coagulation function,renal and liver function indicators,total hospitalization time,ICU hospitalization time,filter use time,and 28-day mortality.The differences in the above indicators between the two groups were compared.The Kaplan-Meier survival curve was drawn,and the 28-day cumulative survival rate of the two groups was analyzed.Results Blood routine and coagulation function indicators:there were no significant differences in red blood cell count(RBC),hemoglobin(Hb) content,platelet count(PLT),prothrombin time(PT),activated partial thromboplastin time(APTT),and international standardized ratio(INR) between the two groups before treatment.After treatment,RBC and Hb were significantly lower than before treatment,PT and APTT were significantly longer than before treatment.There were no significant differences in RBC,Hb,PLT,and INR between the two groups after treatment.However,PT and APTT of the RCA group after treatment were significantly shorter than those of the systemic heparin sodium anticoagulant group [PT(seconds):18.46±6.67 vs.20.11±1.05,APTT(seconds):50.31±10.00 vs.60.55±12.50,both P <0.05].In terms of blood biochemical indicators:there were no significant differences in liver and kidney function indexes between the two groups before treatment,and the levels of serum creatinine(SCr),blood urea nitrogen(BUN) and uric acid(UA) in the two groups were significantly reduced after treatment.However,there were no significant differences in alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),SCr,BUN,UA and bicarbonate root(HCO~-) between the two groups after treatment.After treatment,the blood lactate acid(Lac)level of the whole body heparin sodium anticoagulant group was significantly lower than that before treatment,and there was no significant change in the RCA group.Therefore,the Lac level of the whole-body heparin sodium anticoagulant group was significantly lower than that of the RCA group after treatment(mmol/L:1.07±0.96 vs.2.86±2.49,P <0.05).There was no significant difference in the total hospitalization time and ICU hospitalization time between the two groups;The filter use time in the RCA group after treatment was significantly longer than that in the systemic heparin sodium anticoagulation group(hours:38.72±9.28 vs.21.44±5.62,P <0.05).Kaplan-Meier survival curve analysis showed that there was no significant difference in 28-day cumulative mortality between the two groups(Log-Rank test:χ~2=1.603,P=0.498).Conclusion For AKI patients receiving CRRT in ICU,RCA can reduce the impact on coagulation function,significantly prolong the use time of the filter,and the clinical curative effect is confirmed.更多还原