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目的:观察无肝素透析时采用简化枸橼酸抗凝(RCA)方案进行抗凝的有效性及安全性。方法:选择2016年6月~2017年1月在南京总医院国家肾脏疾病临床医学研究中心行维持性血液透析治疗、因各种原因需行无肝素透析患者共42例,采用简化RCA方案抗凝,前期患者采用方案一,后期患者采用方案二,两种方案都不另外补充钙剂。观察抗凝效果、单次透析持续时间及可能出现的不良反应。结果:13例患者采用方案一抗凝,共完成37例次透析,29例患者采用方案二抗凝,共完成129例次透析,所有治疗均未发生不良反应。完成预定3~4h透析治疗的比例:方案一为75.7%,方案二为98.4%(P<0.01)。将滤器及静脉壶中度以下凝血视为抗凝有效,方案一及方案二的滤器抗凝有效率分别为89.12%、94.57%(P>0.05),而静脉壶抗凝有效率分别为78.3%、90.7%(P<0.05)。方案二患者监测透析前后血气,结果显示透析后离子钙水平与透析前无显著性差异(P>0.05)。结论:简化RCA方案能保证多数患者无肝素透析治疗顺利进行,避免滤器、静脉壶严重凝血及其导致的透析提前中止,特别是方案二,静脉壶凝血的发生率明显下降,并且未发生明显不良反应,对血气结果无明显影响。
Objective: To observe the effectiveness and safety of anticoagulation with simplified citrate anticoagulation (RCA) in heparin-free dialysis. Methods: From June 2016 to January 2017, 42 patients undergoing maintenance hemodialysis were enrolled in National Kidney Disease Clinical Medical Research Center of Nanjing General Hospital. A total of 42 patients undergoing heparin-free dialysis for various reasons were enrolled. A simplified RCA regimen was used for anticoagulation , Pre-patients with a program, late patients with program two, two programs are not additional calcium. Observe the effect of anticoagulation, the duration of single dialysis and possible adverse reactions. Results: Thirteen patients were treated with protocol 1 anticoagulation, 37 completed dialysis were performed, and 29 patients were treated with protocol II anticoagulation. A total of 129 dialysis sessions were completed, and no adverse reactions were observed in all the treatments. Completed scheduled 3 ~ 4h dialysis treatment ratio: the first program was 75.7%, the second program was 98.4% (P <0.01). The filter and venous pot moderate coagulation was considered effective anticoagulation, the first and second program of the filter anticoagulant effective rates were 89.12%, 94.57% (P> 0.05), and venous pot anticoagulant effective rates were 78.3% , 90.7% (P <0.05). Option two patients monitoring blood gas before and after dialysis, the results show that after dialysis ionized calcium levels and no significant difference before dialysis (P> 0.05). Conclusions: Simplification of RCA regimen can ensure that most patients without heparin dialysis treatment smoothly, to avoid filter, venous pot severe coagulation and dialysis caused by early termination, in particular, the second scenario, the incidence of venous pot coagulation decreased significantly, and no significant adverse Reaction, no significant effect on blood gas results.