Abstract:

Objective　To explore the application value of topical sodium citrate combined with low-dose heparin sodium anticoagulation in the treatment of continuous blood purification (CRRT) in patients with sepsis and acute kidney injury. Methods　This research is a randomized controlled trial. Seventy-one patients with sepsis and acute kidney injury (AKI) who were admitted to Shangxian Central Hospital from January 2021 to January 2024 were selected as the research subjects. The patients were divided into the control group (35 cases) and the treatment group (36 cases) by using the random number table method. There were 18 males and 17 females in the control group, aged (53.40±12.03) years. There were 18 males and 18 females in the treatment group, aged (57.97±10.66) years. The control group was treated with CRRT under topical sodium citrate, and the treatment group was treated with CRRT under topical sodium citrate combined with low-dose heparin sodium anticoagulation. Compare the transmembrane pressure (TMP), pressure drop (PFU) and platelet count (PLT) of the two groups before and after treatment at 12 h, 24 h and 48 h; the coagulation grade of the filter and venous reservoir at 24 h after treatment; and the bleeding conditions (skin and mucous membranes, digestive tract, urinary tract, etc.). Independent sample t test, paired t test, χ² test, fisher exact probability and rank sum test were used for statistical analysis. Results　At 12 h, 24 h and 48 h after treatment, the TMP of the treatment group were lower than those of the control group [(114.97±22.65) mmHg (1 mmHg=0.133 kPa) vs. (126.91±22.88) mmHg, (133.28±20.04) mmHg vs. (143.17±20.30) mmHg, (151.14±17.43) mmHg vs. (159.80±17.68) mmHg] (all P<0.05); and the PFU were lower than those of the control group [(97.58±15.22) mmHg vs. (105.71±15.85) mmHg, (118.81±13.72) mmHg vs. (126.51±13.25) mmHg, (140.39±14.19) mmHg vs. (147.43±12.02) mmHg] (all P<0.05); there were no statistically significant difference in the PLT between the two groups (all P>0.05). At 24 hours after treatment, the coagulation grades of the filters and venous reservoirs of the treatment group were better than those of the control group (P<0.05).There was no statistically significant difference in the total incidence of bleeding between the two groups (P>0.05). Conclusion　The treatment of CRRT under topical sodium citrate combined with low-dose heparin sodium anticoagulation can extend the service life of the filter, improve the efficiency of the filter in removing inflammatory mediators, and the therapeutic effect is good without increasing the treatment risk.

Key words: Sodium citrate,  , Anticoagulation,  , Sepsis, 　Acute kidney injury,  , Blood purification

摘要：

目的　探究局部枸橼酸钠联合小剂量肝素钠抗凝在脓毒症并急性肾损伤患者连续性血液净化治疗（CRRT）中的应用价值。方法　本研究为随机对照试验。选取2021年1月至2024年1月单县中心医院收治的71例脓毒症并急性肾损伤患者作为研究对象。采用随机数字表法将患者分为对照组（35例）与治疗组（36例）。对照组男18例，女17例；年龄（53.40±12.03）岁。治疗组男18例，女18例；年龄（57.97±10.66）岁。对照组采用局部枸橼酸钠抗凝下CRRT，治疗组采用局部枸橼酸钠联合小剂量肝素钠抗凝下CRRT。比较两组治疗前和治疗后12 h、24 h、48 h跨膜压（TMP）、压力降（PFU）及血小板计数（PLT）；治疗后24 h滤器及静脉壶凝血分级；出血情况（皮肤黏膜、消化道、泌尿道等）。采用独立样本t检验、配对t检验、χ2检验、Fisher确切概率法和秩和检验进行统计学分析。结果　治疗后12 h、24 h、48 h，治疗组TMP均低于对照组［（114.97±22.65）mmHg（1 mmHg=0.133 kPa）比（126.91±22.88）mmHg、（133.28±20.04）mmHg比（143.17±20.30）mmHg、（151.14±17.43）mmHg比（159.80±17.68）mmHg］（均P<0.05）；PFU均低于对照组［（97.58±15.22）mmHg比（105.71±15.85）mmHg、（118.81±13.72）mmHg比（126.51±13.25）mmHg、（140.39±14.19）mmHg比（147.43±12.02）mmHg］（均P<0.05）；两组PLT比较，差异均无统计学意义（均P>0.05）。治疗后24 h，治疗组滤器及静脉壶凝血分级优于对照组（P<0.05）。两组出血总发生率比较，差异无统计学意义（P>0.05）。结论　局部枸橼酸钠联合小剂量肝素钠抗凝下CRRT治疗可延长滤器使用寿命，改善滤器清除炎症介质的效率，治疗效果较好，且未增加治疗风险。

关键词: 枸橼酸钠,  ,  , 抗凝,  ,  , 脓毒症,  ,  , 急性肾损伤,  ,  , 血液净化