局部枸橼酸抗凝在地震挤压伤患者CRRT治疗中的应用观察
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摘要
目的:分析局部枸橼酸抗凝在地震挤压伤患者CRRT治疗中的效果和安全性,并比较不同实施方式的差异。方法:回顾性的分析汶川地震后我院收治的因挤压伤而接受CRRT治疗的患者中局部枸橼酸抗凝的情况。共计39例患者因挤压伤和多器官功能障碍而接受局部枸橼酸抗凝CRRT治疗。按照不同的实施方式分为A组(23例)以同步输入方式进行,B组(16例)以预充式进行。治疗过程中监测患者的肝肾功能、电解质、凝血指标、血常规等。分析不同治疗组局部枸橼酸抗凝治疗的效果和安全性。结果:39例患者死亡4例,其余35例均康复。存活患者治疗后SCr和BUN指标均较治疗前明显降低,差异有统计学意义,Scr:A组(503±215)μmol/L对(149±129.7)μmol/L,B组(577±227)μmol/L对(180.6±146.5)μmol/L,P<0.05;BUN:A组(26.6±10.4)mmol/L对(9.3±6.9)mmol/L,B组(30.5±8.1)mmol/L对(10.9±5.72)mmol/L,P<0.05。两组滤器后ACT值均较外周血ACT值明显延长且差异有统计学意义,A组:(161±31)s对(122±25)s,B组:(157±33)s对(125±31)s,P<0.05。A组滤器和管路寿命(47.6±11.2)h与B组(41.3±14.5)h相近,A组略长于B组,但两组差异无统计学意义(P>0.05)。其他凝血指标差异无统计学意义。在治疗过程中未发生严重电解质和酸碱平衡紊乱。结论:局部枸橼酸抗凝适于地震挤压伤患者CRRT治疗,这种抗凝方式抗凝效果确切,而且不会加重患者的凝血功能紊乱,不会增加患者活动性出血的风险。同步式局部枸橼酸抗凝在延长滤器和管路方法可能优于预充方式。
Objective: To analysis the efficacy and safety of local citrate anticoagulation in patients with crush syndrome undergoing CRRT after earthquake,and to compare the differences of 2 anticoagulation ways.Methods: The crush syndrome patients received local citrate anticoagulation CRRT after Wenchuan Earthquake were analysed.Thirty-nine patients were divided into 2 groups according the citrate anticoagulation Methods: Group A(n=23) using the WARD method,Group B(n=16) using Palsson method.Liver and renal function,electrolytes level,coagulation indexes were monitored during treatment.Results: Four cases died during treatment.Serum creatinine and BUN levels were significantly lowed after treatment(Scr: Group A 503±215 μmol/L vs 149±129.7 μmol/L,B 577±227 μmol/L vs 180.6±146.5 μmol/L,P<0.05;BUN: Group A 26.6±10.4 mmol/L vs 9.3±6.9 mmol/L,Group B 30.5±8.1 mmol/L vs 10.9±5.72 mmol/L,P<0.05).Post filter ACT were significant longer than peripheral ACT in both groups(Group A: 161±31 s vs 122±25 s,Group B: 157±33 s vs 125±31 s,P<0.05).Filter and circus run time in group A was slightly longer than group B,although no significant difference was noticed in both groups.Conclusion: Local citrate anticoagulation is suitable to crush syndrome patients undergoing CRRT.
Objective: To analysis the efficacy and safety of local citrate anticoagulation in patients with crush syndrome undergoing CRRT after earthquake,and to compare the differences of 2 anticoagulation ways.Methods: The crush syndrome patients received local citrate anticoagulation CRRT after Wenchuan Earthquake were analysed.Thirty-nine patients were divided into 2 groups according the citrate anticoagulation Methods: Group A(n=23) using the WARD method,Group B(n=16) using Palsson method.Liver and renal function,electrolytes level,coagulation indexes were monitored during treatment.Results: Four cases died during treatment.Serum creatinine and BUN levels were significantly lowed after treatment(Scr: Group A 503±215 μmol/L vs 149±129.7 μmol/L,B 577±227 μmol/L vs 180.6±146.5 μmol/L,P<0.05;BUN: Group A 26.6±10.4 mmol/L vs 9.3±6.9 mmol/L,Group B 30.5±8.1 mmol/L vs 10.9±5.72 mmol/L,P<0.05).Post filter ACT were significant longer than peripheral ACT in both groups(Group A: 161±31 s vs 122±25 s,Group B: 157±33 s vs 125±31 s,P<0.05).Filter and circus run time in group A was slightly longer than group B,although no significant difference was noticed in both groups.Conclusion: Local citrate anticoagulation is suitable to crush syndrome patients undergoing CRRT.
引文
[1]VANHOLDER R,et al.Earthquakes and crush syndrome casual-ties:lessons learned from the Kashmir disaster[J].Kidney Int,2007,71(1):17-23.
[2]ODA Y,et al.Crush syndrome sustained in the 1995 Kobe,Japan,earthquake;treatment and outcome[J].Ann Emerg Med,1997,30(4):507-512.
[3]KUTSOGIANNIS D J,et al.Regional citrate anticoagulation incontinuous venovenous hemodiafiltration[J].Am J Kidney Dis,2000,35(5):802-811.
[4]龚德华,季大玺,徐斌.在严重出血倾向重危患者应用枸橼酸抗凝进行连续性静脉静脉血液滤过治疗[J].肾脏病与透析肾移植杂志,2002,11(6):510-514.
[5]苏白海,秦伟,付平.预冲式枸橼酸钠抗凝技术在连续性血液净化高危出血患者中的应用[J].西部医学,2008,20(2):267-270.
[6]PALSSON R,JL.Niles,Regional citrate anticoagulation in contin-uous venovenous hemofiltration in critically ill patients with a highrisk of bleeding[J].Kidney Int,1999,55(5):1991-1997.
[7]SCHMITZ M,et al.Continuous venovenous haemofiltration using acitrate buffered substitution fluid[J].Anaesth Intensive Care,2007,35(4):529-535.
[2]ODA Y,et al.Crush syndrome sustained in the 1995 Kobe,Japan,earthquake;treatment and outcome[J].Ann Emerg Med,1997,30(4):507-512.
[3]KUTSOGIANNIS D J,et al.Regional citrate anticoagulation incontinuous venovenous hemodiafiltration[J].Am J Kidney Dis,2000,35(5):802-811.
[4]龚德华,季大玺,徐斌.在严重出血倾向重危患者应用枸橼酸抗凝进行连续性静脉静脉血液滤过治疗[J].肾脏病与透析肾移植杂志,2002,11(6):510-514.
[5]苏白海,秦伟,付平.预冲式枸橼酸钠抗凝技术在连续性血液净化高危出血患者中的应用[J].西部医学,2008,20(2):267-270.
[6]PALSSON R,JL.Niles,Regional citrate anticoagulation in contin-uous venovenous hemofiltration in critically ill patients with a highrisk of bleeding[J].Kidney Int,1999,55(5):1991-1997.
[7]SCHMITZ M,et al.Continuous venovenous haemofiltration using acitrate buffered substitution fluid[J].Anaesth Intensive Care,2007,35(4):529-535.
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