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肝素封管液与4%枸橼酸钠封管液在无肝素血液透析中的应用比较
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摘要: 目的 比较不同浓度的肝素封管液和枸橼酸钠封管液在无肝素血液透析中的使用情况,探讨更合理的中心静脉导管封管方案。 方法 采用前瞻性、随机、单盲的研究方法,对90例采用临时性中心静脉导管且需要行无肝素透析的终末期肾脏疾病患者进行观察。患者随机分成3组,每组30例:常规肝素组(4 168 U/mL,A组)、低浓度肝素组(2 084 U/mL,B组)、枸橼酸组(4%,C组)。检测患者在透析前,透析结束后0.5 h、2 h、24 h的凝血常规,并记录观察期的出血、血栓、导管功能等指标。 结果 各组患者透析前凝血指标差异无统计学意义,与透析前基线值比较,A组透后0.5 h的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)均延长(P<0.05),2 h的APTT仍延长(P<0.05)、PT恢复正常,24 h的APTT恢复正常;B组透后0.5 h仅APTT延长,透后2 h恢复正常;C组透后的PT、APTT较基线值的差异无统计学意义。在每个检测时间点的3组间比较,A组透后0.5 h的PT、APTT均大于B、C组,2 h的APTT值仍为最长(P<0.05);B组仅透后0.5 h的APTT大于C组(P<0.05)。观察期间,A组的出血事件发生率高于B、C组(P<0.05);3组的血栓发生率差异无统计学意义(P>0.05)。 结论 为减少终末期肾脏疾病患者无肝素透析后的出血并发症,封管液可选用低浓度的肝素或枸橼酸钠封管液。
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