河北医科大学学报 ›› 2022, Vol. 43 ›› Issue (9): 1033-1036,1051.doi: 10.3969/j.issn.1007-3205.2022.09.009

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枸橼酸两段法抗凝结合CVVH治疗对心血管外科术后急性肝肾损伤患者炎症因子及血清HO-1的影响

  

  1. 1.南京医科大学附属淮安第一医院血液净化中心，江苏 淮安 223300；2.南京医科大学附属淮安第一医院肾内科，
    江苏 淮安 223300；3.南京医科大学附属淮安第一医院心内科，江苏 淮安  223300

  • 出版日期:2022-09-25 发布日期:2022-10-02
  • 作者简介:唐正文（1981-），男，江苏淮安人，南京医科大学附属淮安第一医院主治医师，医学学士，从事血液净化研究。
  • 基金资助:
    淮安市科技计划项目（HAB202025）

Effect of two-stage citrate anticoagulation combined with CVVH on inflammatory factors and serum HO-1 in patients with acute liver and kidney injury after cardiovascular surgery

  1. 1.Department of Blood Purification Center, the First People′s Hospital of Huaian City Affiliated to 
    Nanjing Medical University， Jiangsu Province, Huaian 223300， China；2.Department of Nephrology, 
    the First People′s Hospital of Huaian City Affiliated to Nanjing Medical University， Jiangsu Province, 
    Huaian 223300， China； 3.Department of Cardiology， the First People′s Hospital of Huaian City 
    Affiliated to Nanjing Medical University， Jiangsu Province, Huaian 223300， China

  • Online:2022-09-25 Published:2022-10-02

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摘要： 目的 研究枸橼酸两段法抗凝结合连续性静脉-静脉血液滤过(continuous veno venous hemofiltration,CVVH)治疗对心血管外科术后急性肝肾损伤患者炎症因子及血清血红素加氧酶1(heme oxygenase-1,HO-1)的影响。
方法 选择心血管外科术后发生急性肝肾损伤需行CVVH的患者112例，按照随机数字表法分为对照组和研究组，每组56例。对照组给予肝素抗凝，研究组给予枸橼酸两段法抗凝（在滤器前及静脉壶部位分别给予枸橼酸钠抗凝）。比较2组患者抗凝有效性、滤器使用寿命、凝血功能、血清炎症因子及HO-1水平、不良反应发生情况。
结果 2组抗凝有效性差异无统计学意义(P＞0.05)。研究组滤器使用寿命长于对照组(P＜0.05)。治疗后，2组凝血酶原时间(prothrombin time，PT)、部分活化凝血酶原时间(activated partial thromboplastin time，APTT)、凝血酶时间(thrombin time，TT)均长于治疗前，研究组PT、APTT、TT长于对照组(P＜0.05)。治疗后，2组患者C反应蛋白(C-reactive protein，CRP)、白细胞介素6(interleukin-6，IL-6)、肿瘤坏死因子α(tumor necrosis factor-α，TNF-α)、丙二醛(malondialdehyde，MDA)均低于治疗前，研究组CRP、IL-6、TNF-α、MDA低于对照组(P＜0.05)。治疗后，2组HO-1水平低于治疗前，研究组HO-1水平低于对照组(P＜0.05)。研究组并发症发生率低于对照组(P＜0.05)。
结论 枸橼酸两段法抗凝结合CVVH治疗心血管外科术后急性肝肾损伤患者能够降低体内炎症因子水平，增加滤器使用寿命，降低体内HO-1水平，降低出血风险。


关键词: 心血管外科手术, 枸橼酸两段法抗凝, 血液滤过

Abstract: ObjectiveTo study the effect of two-stage citrate anticoagulation combined with continuous veno venous hemofiltration(CVVH) on inflammatory factors and serum HO-1 in patients with acute liver and kidney injury after cardiovascular surgery. 
MethodsA total of 112 patients with acute liver and kidney injury after cardiovascular surgery requiring CVVH were selected and divided into the control group(n=56) and the research group(n=56) according to the random table method. The control group was given heparin for anticoagulation, and the research group was given two-stage citrate anticoagulation(sodium citrate was given for anticoagulation in front of the filter and at the venous pot). Anticoagulant effectiveness,the service time of the filter, serum inflammatory factors and HO-1 between two groups were compared. In addition, adverse reactions were compared in the two groups. 
ResultsThere was no significant difference in anticoagulant effectiveness between two groups after treatment(P＞0.05). The service life of the filter in the research group was longer than that in the control group(P＜0.05). The prothrombin time(PT), activated partial thromboplastin time(APTT), and thrombin time(TT) of the two groups after treatment were longer than those before treatment, and longer in the research group than in the control group(P＜0.05). After treatment, C-reactive protein(CRP), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), and malondialdehyde(MDA) of the two groups were lower than those before treatment, which were lower in the research group than in the control group(P＜0.05). After treatment, the HO-1 levels of the two groups decreased compared with those before treatment, and the research group showed lower results(P＜0.05). The research group had lower incidence of complications than control group(P＜0.05). 
ConclusionTwo-stage citrate anticoagulation combined with CVVH in the treatment of patients with acute liver and kidney injury after cardiovascular surgery can reduce the level of inflammatory factors in the body, increase the service time of the filter, reduce the level of HO-1 in the body, and lower the risk of bleeding.


Key words: cardiovascular surgical procedures, two-stage citrate anticoagulation, hemofiltration

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