Abstract: 【Abstract】〓Objective〓To explore the changes of coagulations and properties of nursing care in septic patients treated with continuous renal replacement therapy (CRRT) using regional citrate anticoagulation (RCA) in the intensive care unit. Methods〓According to our including criteria, 76 patients were included in this retrospective analysis from March 2012 to June 2015. There were 40 patients using RCA (RCA group) and 36cases using low molecular weight heparin as anticoagulations (low molecular heparin group) in CRRT, respectively. Coagulation, arterial blood gas analysis, biochemistry, bleeding and endurance time of filters before and 3 days after treatments were compared between two groups. Results〓Although the serum levels of ureanitrogen (BUN), creatinine (Cr) and lactate (Lac) were significantly decreased in both groups (all p-values were less than 0.05), and no difference was detected between two groups. Notably,no significant changes of prothrombintime (PT), activated partial thromboplastin time (APTT) and platelets (PLT) were found in RCA group, while first two indicators were prolonged and the number of last indicator was decreased in low molecular weight heparin group(all p-values were less than 0.05). The ration of bleeding was significantly reduced and endurance time of filters was obviously increased in RCA group (all p-values were less than 0.05). Conclusion〓In our study, compared with management of low molecular heparin group usedduring CRRT, regional citrate anticoagulationexisted better clinical effects and less side-effects.

Key words: Regional citrate anticoagulation, Sepsis, Continuous renal replacement therapy

摘要： 【摘要】 目的 探讨ICU脓毒血症患者接受连续肾脏替代治疗中枸橼酸钠体外局部抗凝后凝血功能的变化和护理重点。方法〓回顾性分析2012年3月至2015年6月符合本研究76例行CRRT治疗的ICU脓毒血症患者,40例患者采用枸橼酸钠抗凝(RCA),36例患者采用低分子肝素抗凝。对比两组患者治疗前和治疗后3天凝血功能、血气、生化、出血及滤器使用等指标变化。结果〓两组患者治疗后尿素氮(BUN)、肌酐(Cr)、乳酸(Lac)均明显降低(P<0.05),代谢性酸中毒纠正,但两组间比较无统计学差异;治疗后RCA组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血小板总数(PLT)无明显变化,而低分子肝素组PT、APTT明显延长,PLT数量减少,两组间比较具有统计学差异(P<0.05),同时,RCA组出血发生率明显减少,且滤器使用时间明显延长,差异均有统计学意义(P<0.05)。结论〓枸橼酸钠体外局部抗凝连续肾脏替代治疗ICU脓毒血症对患者凝血功能无影响,同时能减少血小板的消耗、降低出血发生率、延长滤器使用寿命。

关键词: 枸橼酸钠, ICU, 脓毒血症, 连续性肾脏替代治疗