关键词: 血液透析, 枸橼酸钠, 分段式抗凝, 凝血功能, 电解质, 不良反应

Abstract: Objective To compare the anticoagulant effect of different concentrations of sodium citrate staged anticoagulation in hemodialysis patients. Methods 150 patients who received hemodialysis in the hospital from January 2019 to January 2021 were selected as the research subjects, and a random number table method was used to divide them into 5 groups with 30 cases in each group. In the 2.5% sodium citrate one-stage anticoagulation group and 4% sodium citrate one-stage anticoagulation group, 2.5% and 4% sodium citrate was pumped at the dialyzer; in the 2.5% sodium citrate staged anticoagulation group and 4% sodium citrate staged anticoagulation group, 2.5% and 4% sodium citrate was pumped at the dialyzer and venous kettle. At the end of treatment, the anticoagulant effect among the five groups was compared. The coagulation function indexes [thrombin time (TT), prothrombin time (PT), fibrinogen (FIB), activated partial thromboplastin time (APTT)], electrolyte indexes [bicarbonate (HCO₃^-), calcium ion (Ca²⁺), potassium ion (K⁺), pH] and free calcium ion [arterial end (A), after filter (V)] were measured and compared before treatment (T₀), on the 1^st h (T₁), 2^nd h (T₂), 3^rd h (T₃) and 4^th h (T₄) after treatment (iCa²⁺). The dialysis adequacy (urea nitrogen clearance rate, urea clearance/volume) of patients among the five groups were compared. During treatment, the adverse reactions among the five groups were counted.Results The anticoagulation effect of 4% sodium citrate staged anticoagulation group was better than that of non heparin group, 2.5% sodium citrate one-stage anticoagulation group and 4% sodium citrate one-stage anticoagulation group, and the total effective rate of anticoagulation was higher than that of non heparin group, 2.5% sodium citrate one-stage anticoagulation group and 4% sodium citrate one-stage anticoagulation group, there were statistical significant differences (P<0.05); there was no statistical significant difference in the total effective rate of anticoagulation between 2.5% sodium citrate segmented anticoagulation group and 4% sodium citrate segmented anticoagulation group (P>0.05); there was no statistical difference in PT, TT, APTT and FIB at T₀, T₁, T₂, T₃ and T₄ among the five groups (P>0.05); compared PT, TT, APTT and FIB among the five groups at T₀ with those at T₁, T₂, T₃ and T₄, there were statistical significant differences (P<0.05); there was no statistical difference in K⁺ and HCO₃^- at T₀ among the five groups (P>0.05); compared K⁺, HCO₃^-, Ca²⁺, pH among the five groups at T₀ with those at T₁, T₂, T₃ and T₄, there were statistical significant differences (P<0.05), 2.5% sodium citrate staged anticoagulation group was lower than non heparin group, 2.5% sodium citrate one-stage anticoagulation group, 4% sodium citrate one-stage anticoagulation group and 4% sodium citrate staged anticoagulation group (P<0.05); compared K⁺, HCO₃^- among the five groups at T₀ with those at T₁, T₂, T₃ and T₄ (P<0.05); there was no significant difference in Ca²⁺ and pH among the five groups at T₀, T₁, T₂, T₃ and T₄ (P>0.05); there was no significant difference in A iCa²⁺ and ViCa²⁺ at T₀, T₁, T₂, T₃ and T₄ among the five groups (P>0.05); compared A iCa²⁺ and ViCa²⁺ among 5 groups at T₀ with those at T₁, T₂, T₃ and T₄, there were statistical significant differences (P<0.05); there was no statistical significant difference in dialysis adequacy (urea nitrogen clearance rate, urea clearance/volume) of patients among the five groups (P>0.05); there was no statistical significant difference in the incidence of adverse reactions among the five groups (P>0.05).Conclusion Pumping 2.5% and 4% sodium citrate in front of dialyzer and venous kettle has high anticoagulant effect in hemodialysis patients, of which pumping 2.5% sodium citrate at the dialyzer and venous kettle can effectively adjust the electrolyte level of patients, and has certain safety.

Key words: Hemodialysis, Sodium citrate, Staged anticoagulation, Coagulation function, Electrolyte, Adverse reaction