心脏外科术后肝功能不全患者枸橼酸抗凝的安全性及有效性研究

doi:10.3969/j.issn.1002-1949.2018.03.009

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摘要目的研究心脏外科术后肝功能不全患者枸橼酸抗凝血液滤过的安全性及有效性。方法回顾性分析2012-02~2017-10阜外医院心脏术后行血液滤过治疗的患者数据。肝功能(Child-Turcotte-Pugh, CTP）评分>4分诊断为肝功能不全，共102例患者符合标准。按抗凝方式不同分为枸橼酸组、肝素组和无抗凝组，对三组血气分析，治疗期间胸液量、输血量，治疗后肌酐值等进行比较分析。结果三组患者血液滤过治疗前基础情况差异均无统计学意义(P＞0.05)。治疗后6 h血气指标pH值、全血剩余碱BE、乳酸及血清钙离子浓度差异均无统计学意义(P＞0.05)。枸橼酸组治疗后体内总钙高于肝素组和无抗凝组，差异有统计学意义(P=0.025)。肝素组血液滤过治疗期间胸液量(819±314)mL，枸橼酸组和无抗凝组血液滤过治疗期间胸液量为(477±268)mL和(414±335)mL。肝素组与枸橼酸组及无抗凝组比较差异有统计学意义（P=0.027和P=0.021）。枸橼酸组滤器寿命(54.050±2.744)h、肝素组为(49.110±1.462)h、无抗凝组(25.690±2.577 )h，三组比较差异有统计学意义（Log- rank检验， χ2=44.11，P＜0.001）。结论心脏外科术后肝功能不全患者枸橼酸抗凝增加滤器使用寿命，不增加术后出血量，不引起内环境失衡及电解质紊乱，安全有效。

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	裴锋博
	龚黎
	陈祖君
	杨秋蓝
	刘红
	姚垚
	施野
	杜鹃
	张海涛
	吴慧

关键词 ：心脏术后, 肝功能不全, 枸橼酸抗凝

收稿日期: 2017-11-02

通讯作者: 吴慧（1977-），女，博士，副主任医师，E-mail:wuhuifw@163.com。

引用本文:

裴锋博，龚黎，陈祖君，杨秋蓝，刘红，姚垚，施野，杜鹃，张海涛，吴慧. 心脏外科术后肝功能不全患者枸橼酸抗凝的安全性及有效性研究 [J]. 中国急救医学, 2018, 38(3): 216-219.
Pei Feng-bo, Gong Li, Chen Zu-jun, Yang Qiu-lan, Liu Hong, Yao Yao, Shi Ye, Du Juan, Zhang Hai-tao, Wu Hui. Safety and efficacy of citrate anticoagulation continuous post-cardiac surgery patients with liver dysfunction . Chinese Journal of Critical Care Medicine, 2018, 38(3): 216-219.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.03.009 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I3/216

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