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中华重症医学电子杂志 ›› 2017, Vol. 03 ›› Issue (03): 197 -201. doi: 10.3877/cma.j.issn.2096-1537.2017.03.009

所属专题: 文献资源库

临床研究 上一篇    下一篇

肿瘤患者连续性肾脏替代治疗枸橼酸与低分子肝素抗凝效果及预后比较
柯昊贤 1, 沈玄韬 1, 余文辉 1, 李梓濠 1, 杨文 1, 季钰尧 1, 陈崇翔 1, 赵擎宇 1 , ( )   
  1. 1. 510060 广州,中山大学肿瘤防治中心医院重症医学科
  • 收稿日期:2017-02-20 出版日期:2017-08-28
  • 通信作者: 赵擎宇
  • 基金资助:
    国家卫生和计划生育委员会专项基金(1311200006402)

Comparison of efficacy and prognosis between citrate and low molecular weight heparin in tumor patients undergoing continuous renal replacement therapy

Haoxian Ke 1, Xuantao Shen 1, Wenhui Yu 1, Zihao Li 1, Wen Yang 1, Yuyao Ji 1, Chongxiang Chen 1, Qingyu Zhao 1 , ( )   

  1. 1. Department of Critical Care Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
  • Received:2017-02-20 Published:2017-08-28
  • Corresponding author: Qingyu Zhao
  • About author:
    Corresponding author: Zhao Qingyu, Email:
目的

比较肿瘤患者行连续性肾脏替代治疗(CRRT)时选用枸橼酸或低分子肝素进行抗凝的效果以及预后。

方法

回顾性分析2012年9月至2016年10月中山大学肿瘤防治中心行CRRT治疗的117例肿瘤患者的临床资料。其中18例患者使用局部枸橼酸抗凝(枸橼酸抗凝组),99例患者使用全身性低分子肝素抗凝(低分子肝素抗凝组)。采用秩和检验比较枸橼酸抗凝组与低分子肝素抗凝组患者CRRT前凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、血小板计数(PLT)及CRRT3 d内PT、APTT、PLT、血红蛋白浓度变化,重症监护病房(ICU)停留时间、住院时间、血滤器寿命差异。

结果

CRRT3 d内,低分子肝素抗凝组患者APTT较枸橼酸抗凝组患者延长,两组患者APTT变化差异有统计学意义[9.11(3.90,9.11)s vs -0.94(-3.40,3.38)s,Z=-4.001,P<0.001];枸橼酸抗凝组患者血滤器寿命长于低分子肝素抗凝组患者,且差异有统计学意义[29.64(19.47,38.94) h vs 17.00(9.50,24.40)h,Z=-3.468,P=0.001]。而两组患者出血发生率、CRRT3 d内PT、PLT、血红蛋白浓度变化差异均无统计学意义。且两组患者住院时间、ICU停留时间以及死亡率差异均无统计学意义。

结论

在肿瘤患者行CRRT时使用枸橼酸较低分子肝素抗凝效果更佳。

Objective

To compare the effect of citrate on anticoagulation efficacy and outcome with low molecular weight heparin during continuous renal replacement treatment (CRRT) in cancer patients.

Methods

Retrospectively analyze the clinical data of 117 patients admitted in intensive care unit (ICU) of Sun Yat-sen University Cancer Center and received CRRT from September 2012 to October 2016. Among all patients, 18 patients received citrate (TCG group), while other 99 patients received low molecular heparin treatment (THG group). Rank-sum test was used to compare prothrombin time (PT), active partial thromboplastin time (APTT), blood platelet (PLT) count before CRRT. In addition, the change of PT, APTT, PLT, hemoglobin concentration during the first three days after CRRT, the stay of ICU and hospital and the filter life were also analyzed.

Results

In three days after CRRT, APTT in THG group was significant longer than patients in TCG group and there was a significant difference of APTT change between two groups [9.11(3.90, 9.11) s vs -0.94(-3.40, 3.38) s, Z=-4.001, P<0.001]. The filter life in TCG group was significant longer than that in THG group [29.64(19.47, 38.94) h vs 17.00(9.50, 24.40) h, Z=3.468, P=0.001]. However, there was no significant difference of PT, PLT, hemoglobin concentration change in 3 days after CRRT between two groups. What′s more, there was no difference of incidence of bleeding, length of ICU and hospital stay, and mortality, either.

Conclusion

In cancer patients, citrate had a better anticoagulation efficacy than low molecular weight heparinduring CRRT.

表1 枸橼酸抗凝组与低分子肝素抗凝组患者一般临床资料比较
表2 枸橼酸抗凝组与低分子肝素抗凝组患者CRRT前主要凝血功能比较[MQR)]
表3 枸橼酸抗凝组与低分子肝素抗凝组患者CRRT3 d内凝血功能变化及预后比较
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