文档介绍：[基金项目]3军队“十五”医学研究指令性课题(NO:01L007[作者单位]南京军区南京总医院解放军肾脏病研究所血液净化中心(南京,210002在严重出血倾向重危患者应用枸橼酸抗凝进行连续性静脉2静脉血液滤过治疗3龚德华季大玺徐斌刘云摘要目的:采用枸橼酸抗凝的连续性静脉2(,观察不同 40C治疗,采用枸橼酸抗凝。其中10例患者不伴有以上两种情况。监测治疗中动脉血气,(变化。结果:所有患者CVVH治疗中滤器前WBACT与治疗,WBACT则显著延长(P<0105。有肝功能损害患者治疗前存在明显代谢性酸中毒,治疗中逐步纠正;持续低氧血症患者CVVH治疗中酸中毒进行性加重;而不伴上述两种情况的患者治疗前无明显代谢性酸中毒,治疗中酸碱状况变化不明显。除伴低氧血症患者治疗中滤器前血清离子钙出现进行性下降外,其余患者治疗中都保持在正常范围。结论:存在肝功能异常患者行CVVH治疗时应用枸橼酸抗凝并无明显低钙血症或酸中毒等代谢并发症,而存在低氧血症患者应用枸橼酸抗凝则可能出现进行性加重酸中毒及低离子钙血症。关键词连续性血液净化枸橼酸抗凝并发症Regionalcitrateanticoagulationinheparin2contraindicativecriticallyillpatientsduringcontinuousvenovenoushemofiltra2tionGONGDehua,JIDaxi,XUBin,XIEHonglang,LIUYun,LILeishiResearchInstituteofNephrology,JinglingHospital,NanjingUniversityClinicalSchoolofMedicine,Nanjing,210002ABSTRACT Objective:hecontraindicationofregionalcitrateanticoagulationbyap2plyingofregionalcitrateanticoagulationinvariouscriticalcarepatientswithbleedingtendency,whoweretreatedbycontinuousvenovenoushemofiltration(CVVH. Methodology:(n=10wereasgroupA,withhypoxemiaasgroupB(n=10,andwithoutbothhepaticfunctionimpairmentandhypoxemiawereasgroupC(n=,andafter4,12,24,36and48hrstreatingbycontinuousbloodpurification(,wholebloodactivatedclottingtime(WBACTpre2andpost2filter,andionizedserumcalciumweredetectedbyroutinemethods. Results:WBACTpre2filtershowedlittlefluctuantthroughthe48hrstermofCBP,andWBACTpost2filtershowedobvi2ousprolongationthanthatpre2filter(P<,,,butdeclinedsignificantly