Clinical efficacy and individualized scheme of segmented citrate anticoagulation in dialysis of patients with high risk of bleeding

Xin PAN; Pan XIE; Yan ZHUO; Huanna LI; Kanfu PENG

doi:10.16016/j.1000-5404.202101211

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Clinical efficacy and individualized scheme of segmented citrate anticoagulation in dialysis of patients with high risk of bleeding

Clinical Medicine | 更新时间：2026-01-09

- Clinical efficacy and individualized scheme of segmented citrate anticoagulation in dialysis of patients with high risk of bleeding
- Journal of Third Military Medical University Vol. 43, Issue 14, Pages: 1372-1378(2021)
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院肾科
- 作者简介：
- 基金信息：
  
  the General Program of National Natural Science Foundation of China(81873606);the National Key Research and Development Program(2016YFC1103003)
- DOI：10.16016/j.1000-5404.202101211
  CLC： R459.5;R969.4;R973.2
- Received：25 January 2021，
  
  Revised：2021-03-05，
  
  Published：30 July 2021
- 稿件说明：
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Xin PAN, Pan XIE, Yan ZHUO, et al. Clinical efficacy and individualized scheme of segmented citrate anticoagulation in dialysis of patients with high risk of bleeding[J]. Journal of Third Military Medical University, 2021, 43(14): 1372-1378.
DOI：

Xin PAN, Pan XIE, Yan ZHUO, et al. Clinical efficacy and individualized scheme of segmented citrate anticoagulation in dialysis of patients with high risk of bleeding[J]. Journal of Third Military Medical University, 2021, 43(14): 1372-1378. DOI： 10.16016/j.1000-5404.202101211.

摘要

目的

对比分段枸橼酸钠抗凝(segmented citrate anticoagulation

SCA)与无肝素抗凝(non-heparin anticoagulation

NA)的安全性和有效性，探讨SCA的个体化方案。

方法

筛选2019年10月至2020年12月符合入组条件的60名高出血风险的透析患者，使用信封法随机分为SCA组和NA组

在透析过程中监测血气、电解质、ACT值，透析结束后记录滤器凝血级别、患者出血情况，比较透析前后的凝血指标，计算kt/v值和超滤量。进一步比较SCA亚组间钙离子、ACT值随时间变化的波动情况。对血浆枸橼酸钠和钙离子清除率进行回归分析。

结果

SCA组抗凝有效的比例(96.7%

63.3%)、kt/v值[(1.21±0.24)

(0.89±0.32)

]

、总超滤量[(2 033.16±708.34)

(1 584.43±868.88)mL

]

明显高于NA组(

0.05)。NA组体内ACT值缩短，SCA组未见明显变化，SCA组中红细胞压积较高[(0.32±0.07)

(0.23±0.04)

0.05

]

的部分患者体外ACT值延长到理想倍数。血浆枸橼酸钠流速与钙离子清除率存在显著线性关系(

=14.671，

0.05)。

结论

SCA在抗凝的有效性和透析的充分性上明显优于NA，不易形成微血栓，在部分患者中可实现个体化的理想抗凝方案。

Abstract

Objective

To compare the safety and effectiveness of anticoagulation strategies between segmented citrate anticoagulation (SCA) and non-heparin anticoagulation (NA)

and investigate the individualized scheme of SCA.

Methods

Sixty patients who met our inclusion criteria and underwent dialysis due to acute and chronic renal failure in our department from October 2019 to December 2020 were recruited in this study

and were randomly divided into SCA group and NA group. Blood gas

electrolyte and activated clotting time (ACT) were monitored during dialysis. The coagulation grade of the filter and hemorrhagic condition were recorded after dialysis. The coagulation indexes before and after dialysis were compared

and the kt/v value and total ultrafiltration volume were calculated. The fluctuation of calcium ion and ACT value among SCA subgroups were further compared. Plasma sodium citrate and calcium clearance were analyzed by regression analysis.

Results

The percentage of effective anticoagulation (96.7%

63.3%)

kt/v value (1.21±0.24

0.89±0.32) and total ultrafiltration volume (2 033.16±708.34

1 584.43±868.88 mL) were significantly higher in the SCA group than the NA group (

0.05). The ACT value was shortened in the NA group

but no such change was seen in the SCA group. In some SCA patients with high hematocrit (0.32±0.07

0.23±0.04

0.05)

their ACT value was prolonged to the ideal multiple. There was a significant linear relationship between plasma sodium citrate flow rate and calcium clearance rate (

=14.671

0.05).

Conclusion

SCA is superior to NA in anticoagulant efficacy

dialysis adequacy and prevention of microthrombosis. An ideal anticoagulant regimen can be realized in part of patients.

关键词

Keywords

references

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