中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (12): 686-690.doi: 10.3969/j.issn.1671-4091.2016.12.009

• 临床研究 • 上一篇    下一篇

分段枸橼酸抗凝进行含钙透析液高通量血液透析的临床观察

张东亮,张潘,张周沧   

  1. 北京大学国际医院血液净化中心
  • 收稿日期:2016-05-17 修回日期:2016-08-08 出版日期:2016-12-12 发布日期:2016-12-05
  • 通讯作者: 张东亮 zhangdongliang@pkuih.edu.cn E-mail:zhangdongliang@pkuih.edu.cn

Observational study of segmented citrate anticoagulation in high flux hemodialysis with calcium-containing dialysate

  • Received:2016-05-17 Revised:2016-08-08 Online:2016-12-12 Published:2016-12-05

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摘要： 目的观察分段枸橼酸抗凝法(segmented citrate anticoagulation,SCA)进行含钙透析液高通量血液透析(high flux hemodialysis，HFHD)的安全性和有效性。方法对高出血风险的维持性血液透析患者进行SCA-HFHD 治疗，监测患者血压、脉搏、透析治疗参数、体外循环不同位置血钙离子浓度(Ca2+)，测算尿素下降率(urine reduction ratio，URR)和溶质清除指数(Kt/V)评估单次透析充分性、透析后管路凝血情况，对发生凝血与未发生凝血的治疗中上述参数进行对比分析。结果共观察了19 例患者133 次SCA-HFHD 治疗，有效血流量(205.8±22.5)ml/min，透析液流量(370.7±105.0)ml/min，持续泵入4%枸橼酸三钠的速度为：透析器前(314.6 ± 14.2) ml/h，透析器后(53.5±6.3)ml/h；体外循环动脉端Ca2+在(0.76±0.16)mol/L，静脉回血端Ca2+在(0.45±0.14)mmol/L；单次治疗URR 为65.9%±9.8%，Kt/V 为(1.38±0.31)；SCA- HFHD 治疗前后血红蛋白浓度稳定(94.8±13.8)g/L 对(94.3±12.0)g/L，t=0.481，P =0.639)；无凝血治疗80 例次(60.2%)；与发生凝血的治疗相比，未发生凝血的治疗在第120 分钟时的静脉压显著低于前者(72.0±37.7)mmHg 对(91.1±31.5)mmHg,t=-3.055,P=0.003。结论对于高出血风险的患者，SCA-HFHD 是安全有效的。

关键词: 枸橼酸三钠, 抗凝, 血液透析, 高通量, 钙离子

Abstract: Target To observe the safety and efficacy of segmented citrate anticoagulation (SCA) in high flux hemodialysis (HFHD) with calcium-containing dialysate. Methods The maintenance hemodialysis patients with high risk of bleeding were treated by SCA-HFHD. Clinical parameters were observed regularly during the treatment, including blood pressure, pulse, dialysis parameters, and blood ionized calcium levels (Ca2 + ) at different points in the dialysis pipeline. The urine reduction ratio (URR) and Kt/V were calculated, and the coagulation situation in dialyzers and tubes were recorded. The above parameters were compared between sessions with and without coagulation. Results A total of 133 SCA-HFHD sessions in 19 patients were studied. The mean effective blood volume was 205.8±22.5 ml/min, mean dialysate volume was 370.7± 105.0 ml/min, and mean volume of 4% trisodium citrate was 314.6±14.2 ml/h before dialyzer and 53.5±6.3 ml/h after dialyzer. The mean blood Ca2+ level was 0.76±0.16 mol/L at inlet point of blood line and 0.45±0.14 mmol/L at outlet point of blood line. The mean URR was 65.9%±9.8% and Kt/V was 1.38±0.31 in a session. Hemoglobin levels before and after SCA-HFHD treatments were stable (94.8±13.8 g/L vs. 94.3±12.0 g/L, t= 0.481, P=0.639). There were 80 sessions (60.2%) without coagulation. Venous pressures were significantly lower in sessions without coagulation than in sessions with coagulation (72.0 ± 37.7 mmHg vs. 91.1 ± 31.5 mmHg, t=-3.055, P=0.003). Conclusion SCA-HFHD is a safe and effective treatment for patients with high risk of bleeding.

Key words: Trisodium citrate, Anticoagulation, Hemodialysis, High-flux, Ionized calcium