摘要
目的:观察无肝素透析滤过治疗尿毒症并上消化道出血的疗效。方法:选取2013年1月至2017年1月我院收治的120例尿毒症并上消化道出血患者,随机分为两组,各60例,A组给予局部枸橼酸抗凝血液透析,B组给予无肝素透析滤过治疗,比较两组透析前后活化部分凝血活酶时间(APTT)、活化凝血时间(ACT)、胃液pH、血生化指标与血气分析,并观察两组透析器与管路凝血发生情况。结果:透析后,B组APTT、ACT明显短于A组(P<0.05),且胃液pH明显大于A组(P<0.05);B组BUN、SCr水平明显低于A组(P <0.05),两组Ca2+、K+水平、血pH比较无明显差异(P>0.05);B组HCO3-水平明显低于A组(P<0.05);A组凝血发生率10.00%,B组13.33%,两组比较无明显差异(P>0.05)。结论:无肝素透析滤过治疗尿毒症并上消化道出血可有效改善患者肾脏功能与胃液pH,纠正钾异常,但局部枸橼酸抗凝血液透析体外循环凝血优于无肝素透析。
Objective:To observe the curative effect of heparin-free hemodiafiltration on uremia with upper gastrointestinal bleeding.Methods:120 patients with uremia complicated with upper gastrointestinal bleeding in our hospital from January 2013 to January 2017 were randomly divided into two groups,60 cases in each group.Group A was treated with local citrate anticoagulant hemodialysis,and group B was treated with heparin-free hemodiafiltration.The activated partial thromboplastin time(APTT),activated clotting time(ACT),pH of gastric juice,blood biochemical indicators and blood gas analysis before and after dialysis were compared between the two groups.The occurrence of dialyzer and tube coagulation in both groups was observed.Results:After dialysis,the APTT and ACT in group B were significantly shorter than those in group A(P<0.05),and the pH of gastric juice was significantly higher than that in group A(P<0.05).The levels of BUN and SCr in group B were significantly lower than those in group A(P<0.05).There were no significant differences in the level of Ca^2+or K^+or blood pH between the two groups(P>0.05).The HCO3^-levels in group B were significantly lower than those in group A(P<0.05).There was no significant difference in the incidence of coagulation between group A and group B(10.00%vs 13.33%)(P>0.05).Conclusion:Heparin-free hemodiafiltration for uremia with upper gastrointestinal bleeding can effectively improve the renal function and pH of gastric juice,and correct potassium abnormalities.Local citrate anticoagulant hemodialysis is superior to heparin-free dialysis in terms of extracorporeal circulation.
作者
邓成爱
卢丽华
吴琦
LU Lihua;WU Qi(The First People's Hospital of Zhaotong,Yunnan Zhaotong 657000,China)
出处
《河北医学》
CAS
2019年第2期272-276,共5页
Hebei Medicine
基金
云南省卫生科技计划项目
(编号:2015NS2411)
关键词
抗凝血液透析
无肝素透析
尿毒症
上消化道出血
Anticoagulant hemodialysis
Heparin-free dialysis
Uremia
Upper gastrointestinal bleeding
