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目的探讨连续性静脉-静脉血液滤过中采取局部枸橼酸抗凝的价值。方法将2011年9月至2015年12月接受治疗的78例行连续性静静脉血液滤过(CVVH)患者纳入本研究。按照入院顺序抽签后随机分为实验组和对照组。观察患者治疗前后血清游离钠、血钠、碳酸氢根浓度、血肌酐、尿素氮水平、治疗时间、实际超滤量以及治疗安全性。结果两组治疗前后血清游离钠、血钠、碳酸氢根浓度比较差异未见统计学意义(P>0.05),实验组治疗后血肌酐、尿素氮水平均低于治疗前和对照组,差异有统计学意义(P<0.05),对照组治疗后血肌酐、尿素氮水平均低于治疗前,差异有统计学意义(P<0.05)。实验组治疗时间、实际超滤量均高于对照组,差异有统计学意义(P<0.05)。实验组治疗安全性高于对照组,差异有统计学意义(χ~2=4.446,P<0.05)。结论 CVVH过程中,采取局部枸橼酸抗凝,对于患者血清游离钠、血钠、碳酸氢根浓度无明显影响,可改善血肌酐、尿素氮水平,延长治疗时间,增加实际超滤量,安全性较高。
Objective To investigate the value of local citrate anticoagulation in continuous venovenous hemofiltration. Methods 78 consecutive CVVH patients treated from September 2011 to December 2015 were enrolled in this study. In accordance with the order of admission randomly divided into experimental group and control group. Serum free sodium, serum sodium, bicarbonate concentration, serum creatinine, urea nitrogen level, treatment time, actual ultrafiltration volume and treatment safety were observed before and after treatment. Results Before and after treatment, the concentrations of serum free sodium, sodium and bicarbonate in serum had no significant difference (P> 0.05). The levels of serum creatinine and urea nitrogen in the experimental group were lower than those before treatment and in the control group Statistical significance (P <0.05). The serum creatinine and blood urea nitrogen in the control group after treatment were all lower than those before treatment, the difference was statistically significant (P <0.05). The experimental group treated with the actual ultrafiltration volume were higher than the control group, the difference was statistically significant (P <0.05). The safety of experimental group was higher than that of control group, the difference was statistically significant (χ ~ 2 = 4.446, P <0.05). Conclusion In the course of CVVH, anticoagulation with local citrate has no effect on serum free sodium, serum sodium and bicarbonate concentration, and can improve serum creatinine and urea nitrogen, prolong the treatment time, increase the actual ultrafiltration volume, Sex is higher.