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目的研究商品化枸橼酸-葡萄糖抗凝溶液A(ACD-A液)应用于急性肾衰竭伴出血倾向高危患者连续性血液净化(CBP)抗凝的疗效及安全性。方法 12例伴出血或出血倾向患者行连续性静脉-静脉血液滤过(CVVH),分为局部枸橼酸抗凝(RCA)组和对照组。RCA组共 38例次,应用ACD-A液为抗凝剂自滤器前输入;于血路管的静脉侧补充10％葡萄糖酸钙。 ACD-A液及钙剂输入速度根据血清及滤器后离子钙(iCa2+)水平调整以维持滤器后iCa2+0．30- 0．40 mmol／L．血清iCa2+0．9-1．2 mmol／L。对照组应用小剂量低分子肝素钠(1700-2500 IU,每 12～24 h 1次)或不使用抗凝剂。比较两组血滤器使用时间;监测RCA组治疗前后血浆凝血酶原时间(PT)和部分凝血活酶时间(APTT)、酸碱变化及血清iCa2+、钠离子(Na+)水平。结果 RCA 组和对照组CBP总治疗时间分别为1192．5 h、596 h,各使用血滤器62个、42个。24 h和48 h 血滤器的可使用率分别为:RCA组65．3％和24．5％;对照组14．5％和0。达使用终点的血滤器平均寿命,RCA组显著长于对照组[(29．4±21．0)(1．5-71．5)h比(14．2±8．2)(4．5-40)h,P<0．01]。 ACD-A抗凝治疗中,血PT、APTT、pH、碱剩余、iCa2+、Na+水平较治疗前基本保持不变;无1例次出血加重或新发出血、无1例次诱发肢体抽搐。结论 ACD-A液抗凝剂在有效监测的情况下,应用于伴出血倾向患者的CBP,是一种简便易行、安全有效的方法,有一定的临床应用及推广价值。
Objective To study the efficacy and safety of commercial citric acid-glucose anticoagulant solution A (ACD-A solution) for continuous blood purification (CBP) anticoagulation in patients with acute renal failure and high risk of bleeding. Methods Twelve patients with hemorrhage or bleeding tendency underwent continuous venovenous hemofiltration (CVVH). The patients were divided into local citrate anticoagulation (RCA) group and control group. A total of 38 cases of RCA group, the application of ACD-A solution as anticoagulant input from the filter before; in the blood line venous side of 10% calcium gluconate. ACD-A fluid and calcium infusion rate adjusted according to serum and post-filter ionized calcium (iCa2 +) levels to maintain filter iCa2 + 0.30-0.40 mmol / L. Serum iCa2 + 0.9-1.2 mmol / L. Control group, low-dose low-molecular-weight heparin sodium (1700-2500 IU, every 12 ~ 24 h 1) or without anticoagulants. The duration of blood clotting was compared between the two groups. The prothrombin time (PT), partial thromboplastin time (APTT), acid-base changes, serum iCa2 + and sodium ion (Na +) levels were measured before and after treatment in RCA group. Results The total treatment time of CBP in RCA group and control group were 1192.5 h and 596 h, respectively, and 62 and 42 blood filters were used. The availability of 24 h and 48 h hemofilters were 65.3% and 24.5% in the RCA group and 14.5% and 0% in the control group, respectively. The end-use blood filter average life span was significantly longer in the RCA group than in the control group [(29.4 ± 21.0) (1.5-71.5) h vs (14.2 ± 8.2) (4.5- 40) h, P <0.01]. ACD-A anticoagulant therapy, blood PT, APTT, pH, alkaline excess, iCa2, Na levels remained unchanged compared to before treatment; no bleeding in 1 case or new hemorrhage, no case of convulsions of the limbs. Conclusions The ACD-A anticoagulant is an easy, safe and effective method for CBP patients with hemorrhagic tendency under effective monitoring. It has certain clinical application and promotion value.