中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (09): 672-674.doi: 10.3969/j.issn.1671-4091.2023.09.008

• 临床研究 • 上一篇    下一篇

不同含钙浓度透析液用于简化枸橼酸抗凝血液透析的前瞻性自身交叉对照研究

王 炜   李月红   武向兰   杨 画   吕佳璇   许慧莹   

  1. 102218 北京，1清华大学附属北京清华长庚医院肾内科 清华大学临床医学院
  • 收稿日期:2023-06-01 修回日期:2023-06-06 出版日期:2023-09-12 发布日期:2023-09-12
  • 通讯作者: 李月红 E-mail:lyha01051@btch.edu.cn
  • 基金资助:
    首都卫生发展科研专项(2022-3-2243)；首都特色临床应用研究(Z181100001718129)

Prospective and self-crossover control study of dialysates containing different calcium concentrations for simplified citric acid anticoagulant hemodialysis

WANG Wei, LI Yue-hong, WU Xiang-lan, YANG Hua, LYU Jia-xuan, XU Hui-ying   

  1. Department of Nephrology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
  • Received:2023-06-01 Revised:2023-06-06 Online:2023-09-12 Published:2023-09-12
  • Contact: 102218 北京，1清华大学附属北京清华长庚医院肾内科 清华大学临床医学院 E-mail:lyha01051@btch.edu.cn

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摘要： 目的  探讨不同含钙浓度透析液用于简化枸橼酸抗凝血液透析的有效性。 方法 32例高出血风险血液透析患者采用自身交叉对照，分别使用1.25 mmol/L(A组)和1.5 mmol/L(B组)含钙透析液，进行64例次简化枸橼酸抗凝血液透析。测定不同时间点血游离钙水平，调整枸橼酸用量，监测透析指标及透析充分性(Kt/V)。 结果  ①A组和B组抗凝有效率分别为100%、93.8%。②A组枸橼酸输入速度低于B组[(390.9±24.0) ml/h比(410.9±20.7) ml/h，t =-3.569，P =0.001)；A组透析2h滤器后游离钙[(0.66±0.13) mmol/L比(0.80±0.12) mmol/L，t=-4.428，P ＜0.001]、透析4h滤器前游离钙[(0.91±0.11)mmol/L比(1.00±0.13)mmol/L，t=-2.917，P =0.005]，均低于B组。③2组间Kt/V比较无显著性差异[(1.16±0.22)mmol/L比(1.18±0.20)mmol/L，t=-0.380，P =0.706]。 结论 1.5 mmol/L含钙透析液有效抗凝，血游离钙水平更安全，更适合简化枸橼酸抗凝血液透析。

关键词: 枸橼酸, 血液透析, 抗凝, 含钙透析液

Abstract: Objective To investigate the effectiveness of different calcium concentrations in dialysate for simplified citric acid anticoagulant hemodialysis.  Methods  A total of 32 hemodialysis patients with high risk of bleeding were treated with 1.25mmol/L (group A) or 1.5 mmol/L (group B) calcium-containing dialysate for 64 times of simplified citric acid anticoagulant hemodialysis by self-crossover control method. Blood free calcium level was measured at different dialysis time points, the pumping speed of citric acid was adjusted, and the dialysis indexes and dialysis adequacy (Kt/V) were recorded.  Results  ①The anticoagulant efficacies of group A and group B were 100% and 93.8% respectively. ②The pumping speed of citric acid in group A was lower than that in group B [(390.9±24.0) ml/h vs.（410.9±20.7）ml/h, t=-3.569, P=0.001]. In group A, the free calcium after the filter at 2 hours of dialysis [(0.66±0.13) mmol/L vs. (0.80±0.12) mmol/L, t=-4.428, P<0.001) and the free calcium before the filter at 4 hours of dialysis [(0.91±0.11) mmol/L vs. (1.00±0.13) mmol/L, t=-2.917, P=0.005) were lower than those in group B. ③There was no significant difference in Kt/V between the two groups [(1.16±0.22) mmol/L vs. (1.18±0.20)mmol/L, t=-0.380, P=0.706].  Conclusion  Dialysate containing calcium 1.5mmol/L can achieve effective anticoagulation with safer blood free calcium concentration, and it may be appropriate for simplified citric acid anticoagulant hemodialysis. 

Key words: Citric acid, Hemodialysis, Anticoagulation, Calcium-containing dialysate

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