目的 使用含钙置换液行日间连续性肾脏替代治疗,采取两段式枸橼酸抗凝方案,观察其抗凝效果与安全性。方法 采用方便抽样法,选取2021年10月—2022年9月武汉市某三级甲等医院行日间连续性肾脏替代治疗的患者96例,将病例按2 ∶ 1随机分为试验组和对照组。试验组62例采用两段式枸橼酸抗凝方案,对照组31例使用传统枸橼酸抗凝方式。比较两组堵管发生率、下机后滤器和静脉壶凝血等级、治疗2 h体外循环钙离子浓度、治疗结束时酸碱平衡电解质状态和总钙/离子钙比值的差异。结果 试验组堵管发生率低于对照组,差异有统计学意义（χ2=4.980,P<0.05）;试验组静脉壶凝血等级优于对照组,差异有统计学意义（Z=3.556,P<0.001）;试验组治疗2 h静脉端钙离子浓度低于对照组,差异有统计学意义（t=7.418,P<0.001）;治疗结束时,两组的酸碱平衡电解质状态均在正常范围内,总钙/离子钙<2.5,组间差异无统计学意义（P>0.05）。结论 在应用含钙置换液行日间连续性肾脏替代治疗时,两段式枸橼酸抗凝有助于降低堵管发生率,改善静脉壶的抗凝结局,且未增加枸橼酸的蓄积风险。
Objective To investigate the anticoagulant effect and safety of two-stage regional citrate anticoagulation regimen used in daytime continuous renal replacement therapy with calcium-containing replacement fluid. Methods A total of 96 patients who received daytime renal replacement therapy in a tertiary hospital in Wuhan were selected and randomly divided into experimental group and control group by 2:1. Two-stage citrate anticoagulation regimen was used in experimental group and traditional citrate anticoagulation regimen was used in control group. The incidence of tube plugging,coagulation grade of the filter and vein pot after disoperation,calcium ion concentration 2 h after beginning,and relative blood gas index and total calcium/ionic calcium ratio at the end of treatment were compared between the two groups. Results The incidence of tube plugging in the experimental group was lower than that in the control group,the difference was statistically significant（χ2=4.980,P<0.05）. The coagulation grade of the vein pot in the experimental group was significantly better than the control group,the difference was statistically significant（Z=3.556,P<0.001）.The 2 h venous calcium concentration of experimental group was lower than that of control group,and the difference was statistically significant（t=7.418,P<0.001）. At the end of treatment,the relevant blood gas markers in both groups were within the normal range,total calcium/ionic calcium<2.5,the difference was not statistically significant（P>0.05）. Conclusion Two-stage regional citrate anticoagulation can reduce the incidence of tube clotting in continuous renal replacement therapy with calcium replacement fluid and improve the anticoagulant effect of vein pot. At the same time,the scheme does not increase the risk of citrate accumulation,so it is a safe anticoagulant choice.
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