目的:分析局部枸橼酸抗凝在地震挤压伤患者CRRT治疗中的效果和安全性,并比较不同实施方式的差异。方法:回顾性的分析汶川地震后我院收治的因挤压伤而接受CRRT治疗的患者中局部枸橼酸抗凝的情况。共计39例患者因挤压伤和多器官功能障碍而接受局部枸橼酸抗凝CRRT治疗。按照不同的实施方式分为A组(23例)以同步输入方式进行,B组(16例)以预充式进行。治疗过程中监测患者的肝肾功能、电解质、凝血指标、血常规等。分析不同治疗组局部枸橼酸抗凝治疗的效果和安全性。结果:39例患者死亡4例,其余35例均康复。存活患者治疗后SCr和BUN指标均较治疗前明显降低,差异有统计学意义,Scr:A组(503±215)μmol/L对(149±129.7)μmol/L,B组(577±227)μmol/L对(180.6±146.5)μmol/L,Plt;0.05;BUN:A组(26.6±10.4) mmol/L对(9.3±6.9)mmol/L,B组(30.5±8.1)mmol/L对(10.9±5.72)mmol/L,Plt;0.05。两组滤器后ACT值均较外周血ACT值明显延长且差异有统计学意义,A组:(161±31) s 对 (122±25)s,B组:(157±33)s 对 (125±31) s,Plt;0.05。A组滤器和管路寿命(47.6±11.2)h与B组(41.3±14.5)h相近,A组略长于B组,但两组差异无统计学意义(Pgt;0.05)。其他凝血指标差异无统计学意义。在治疗过程中未发生严重电解质和酸碱平衡紊乱。结论:局部枸橼酸抗凝适于地震挤压伤患者CRRT治疗,这种抗凝方式抗凝效果确切,而且不会加重患者的凝血功能紊乱,不会增加患者活动性出血的风险。同步式局部枸橼酸抗凝在延长滤器和管路方法可能优于预充方式
目的探讨亚低温联合持续肾脏替代治疗（CRRT）对心脏外科术后重症心力衰竭的临床效果 方法回顾性分析我中心2009年2月至2013年12月行心脏外科术后重症心力衰竭38例患者的临床资料，其中男18例、女20例，年龄55～74岁，虽应用大剂量血管活性药物及主动脉内球囊反搏（IABP）辅助循环，心力衰竭无改善，采用CRRT及亚低温联合治疗。监测患者在联合治疗前后心脏指数（CI）值、混合静脉血氧饱和度（SvO2）、尿量、肌酐（Cr）及乳酸（Lac）的变化。 结果亚低温联合CRRT治疗后，患者CI较治疗前明显改善[（2.3± 0.7）L/（min· m2）vs.（1.8± 0.2）L/（min· m2）]，SvO2升高（62%± 5%vs.50%± 4%），乳酸明显降低[（8.6± 2.3）mmol/L vs.（3.0± 1.1）mmol/L]，尿量明显增加[（2.5± 0.9）ml/h vs.（1.0± 0.7）ml/h]，Cr明显下降[（140± 19）mmol/L vs.（292± 24）mmol/L]。 结论亚低温联合CRRT治疗心脏外科术后重症心力衰竭能有效改善循环功能，且操作简单易行。
ObjectiveTo evaluate the economics of nafamostat mesylate compared with unfractionated heparin for continuous renal replacement therapy anticoagulation. MethodsA decision tree model was constructed to calculate the cost difference between the two anticoagulation methods. Survival analysis data comes from retrospective literature in Asian countries. The cost data comes from procurement data and the prices of medical and health services in some regions. A 72-hour scenario analysis is performed and a sensitivity analysis is performed on key parameters. ResultsThe basic analysis results showed that compared with the unfractionated heparin group, the total cost difference of nafamostat in the 144-hour CRRT treatment was 5 350.34 yuan, and the unfractionated heparin was more economical. In the 72-hour scenario analysis, unfractionated heparin is also more economical. Univariate sensitivity analysis showed that the cost of single-use hemodialysis filters and supporting pipelines and the cost of plasma antithrombin Ⅲ activity (AT-Ⅲ) measurement had a greater impact on the change of the cost difference. The results of probability sensitivity analysis show that the model structure is stable and robust. When the unit price of nafamostat is about 110.82 yuan/piece, the cost of nafamostat and unfractionated heparin in 144-hour CRRT treatment is both 19 185.37 yuan, and the cost difference is 0.ConclusionWhen the unit price of nafamostat mesylate drops to a sufficiently low level, it could have an advantageous health economy.