关键词: 血液滤过, 危重患者, 术后出血, 枸橼酸钠, 肝素, 封管液

Abstract: Objective To investigate the effects of 4% sodium citrate, 4000U/mL heparin sodium and 6 250 U/mL heparin sodium on the critically ill hemofiltration patients after operation, and to analyze the relationship between the different locking solutions and the hemorrhage-related complications. Methods During our study period, 116 postoperation patients underwent bedside hemofiltration who were admitted to the intensive care unit (ICU) of Peking University First Hospital from February 2014 to July 2016, were analyzed. We conducted a retrospective cohort study. Compare the effectiveness and safety of use of 4% sodium citrate, 4 000 U/mL heparin sodium, 6 250 U/mL heparin on catheters locking. The results of the observation included blood loss index, postoperative blood loss, catheter patency, clotting function, and catheter infection rate 3 days and 10 days after surgery. Results A total of 116 patients received 439 post-hemofiltration closures during the study period. The blood loss index and significant blood loss at 3 and 10 days after sealing with 6 250 U/mL heparin sodium were significantly higher than those in the 4% citric acid group (P<0.001) and the 4 000 U/mL heparin sodium group (P<0.001). The result of PT test had no significantly different between the three groups of locking solutions, P=0.833. APTT was significantly different between the 4% citrate group and the 6 250 U/mL heparin group, P=0.023. The 4% citrate group had a higher rate of catheter dysfunction than the two heparin group by 6.91% vs4.92% vs2.98%, P>0.05, but not statistically significant. There was no difference in the rate of catheter related blood stream infection among the three groups of locking solutions, P>0.05. Conclusion 4% citrate and 4 000 U/mL heparin, 6 250 U/mL heparin locking solutions are equally effective in maintaining catheter patency in patients with hemofiltration. 6 250 U/mL heparin group had a higher risk of hemorrhage-related complications after surgery. 4% citrate group had a lower risk for systemic anticoagulation than 6 250 U/mL heparin group. The three locking solutions are similarly in catheter related blood stream infections.

Key words: Hemofiltration, Critical ill patient, Postoperative hemorrhage, Citrate, Heparin, Locking solution