河南医学研究2024,Vol.33Issue(2) :341-344.DOI:10.3969/j.issn.1004-437X.2024.02.038

不同抗凝方案在接受连续肾脏替代疗法的急诊脓毒症患者中的应用效果

Application Effect of Different Anticoagulant Regimens in Emergency Sepsis Patients Receiving Continuous Renal Replacement Therapy

师延刚 于晓琳 耿玉安 刘瑞芳
河南医学研究2024,Vol.33Issue(2) :341-344.DOI:10.3969/j.issn.1004-437X.2024.02.038

不同抗凝方案在接受连续肾脏替代疗法的急诊脓毒症患者中的应用效果

Application Effect of Different Anticoagulant Regimens in Emergency Sepsis Patients Receiving Continuous Renal Replacement Therapy

师延刚 1于晓琳 1耿玉安 1刘瑞芳1
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作者信息

  • 1. 河南省直第三人民医院急重症医学科,河南郑州 450000
  • 折叠

摘要

目的 对比不同抗凝方案在连续肾脏替代疗法(CRRT)的急诊脓毒症患者中的应用效果,并分析其对患者炎症状态及出血风险的影响.方法 回顾性分析2020年1月至2022年12月医院收治的接受CRRT治疗的110例急诊脓毒症患者的资料,将接受低分子肝素抗凝的58例患者纳入对照组,将接受局部枸橼酸抗凝的52例患者纳入观察组.比较两组患者治疗前后炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]与凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)]水平,并采用房颤抗凝治疗出血评分系统评估两组患者治疗后的出血风险.结果 治疗后,两组患者血清TNF-α、IL-6水平均降低,且观察组水平低于对照组(P<0.05);两组患者PT、APTT降低,Fib水平升高,且观察组PT、APTT低于对照组,Fib高于对照组(P<0.05).观察组房颤抗凝治疗出血评分系统评分低于对照组(P<0.05).结论 与低分子肝素抗凝相比,采用局部枸橼酸抗凝方式可更好地减轻急诊脓毒症CRRT治疗患者炎症反应,改善凝血功能,降低出血风险.

Abstract

Objective To compare the effects of different anticoagulation regimens on emergency sepsis patients treated with continuous renal replacement therapy(CRRT),and analyze the impact on their inflammatory status and bleeding risk.Methods Retrospective analysis of data from 110 emergency sepsis patients admitted to the hospital from January 2020 to December 2022 who received CRRT treatment.58 patients who received low-molecular-weight heparin anticoagulation were included in the control group,and 52 patients who received local citrate anticoagulation were included in the observation group.The levels of inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)]and coagulation function indexes[prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib)]were compared between the two groups before and after treatment,and the atrial fibrillation anticoagulant therapy bleeding scoring system was used to evaluate the bleeding risk after treatment.Results After treatment,serum TNF levels in both groups of patients-α、The average level of IL-6 water decreased,and the level in the observation group was lower than that in the control group(P<0.05).The PT and APTT levels decreased and Fib levels increased in both groups of patients,and the observation group had lower PT and APTT levels than the control group,while Fib levels were higher than the control group(P<0.05).The observation group had lower bleeding scores in the anticoagulant therapy for atrial fibrillation compared to the control group(P<0.05).Conclusion Compared with low molecular weight heparin anticoagulation,the use of local citrate anticoagulation can better alleviate the inflammatory response,improve coagulation function,and reduce the risk of bleeding in emergency sepsis patients undergoing CRRT treatment.

关键词

脓毒症/连续肾脏替代疗法/抗凝/炎症状态/出血风险

Key words

sepsis/continuous renal replacement therapy/anticoagulation/inflammatory status/bleeding risk

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出版年

2024
河南医学研究
河南省医学科学院

河南医学研究

影响因子:0.979
ISSN:1004-437X
参考文献量13
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