目的 探讨不同含钙浓度透析液用于简化枸橼酸抗凝血液透析的有效性。 方法 32例高出血风险血液透析患者采用自身交叉对照，分别使用1.25 mmol/L(A组)和1.5 mmol/L(B组)含钙透析液，进行64例次简化枸橼酸抗凝血液透析。测定不同时间点血游离钙水平，调整枸橼酸用量，监测透析指标及透析充分性(Kt/V)。 结果 ①A组和B组抗凝有效率分别为100%、93.8%。②A组枸橼酸输入速度低于B组[(390.9±24.0) ml/h比(410.9±20.7) ml/h，t =-3.569，P =0.001)；A组透析2h滤器后游离钙[(0.66±0.13) mmol/L比(0.80±0.12) mmol/L，t=-4.428，P ＜0.001]、透析4h滤器前游离钙[(0.91±0.11)mmol/L比(1.00±0.13)mmol/L，t=-2.917，P =0.005]，均低于B组。③2组间Kt/V比较无显著性差异[(1.16±0.22)mmol/L比(1.18±0.20)mmol/L，t=-0.380，P =0.706]。 结论 1.5 mmol/L含钙透析液有效抗凝，血游离钙水平更安全，更适合简化枸橼酸抗凝血液透析。
Objective To investigate the effectiveness of different calcium concentrations in dialysate for simplified citric acid anticoagulant hemodialysis. Methods A total of 32 hemodialysis patients with high risk of bleeding were treated with 1.25mmol/L (group A) or 1.5 mmol/L (group B) calcium-containing dialysate for 64 times of simplified citric acid anticoagulant hemodialysis by self-crossover control method. Blood free calcium level was measured at different dialysis time points, the pumping speed of citric acid was adjusted, and the dialysis indexes and dialysis adequacy (Kt/V) were recorded. Results ①The anticoagulant efficacies of group A and group B were 100% and 93.8% respectively. ②The pumping speed of citric acid in group A was lower than that in group B [(390.9±24.0) ml/h vs.（410.9±20.7）ml/h, t=-3.569, P=0.001]. In group A, the free calcium after the filter at 2 hours of dialysis [(0.66±0.13) mmol/L vs. (0.80±0.12) mmol/L, t=-4.428, P<0.001) and the free calcium before the filter at 4 hours of dialysis [(0.91±0.11) mmol/L vs. (1.00±0.13) mmol/L, t=-2.917, P=0.005) were lower than those in group B. ③There was no significant difference in Kt/V between the two groups [(1.16±0.22) mmol/L vs. (1.18±0.20)mmol/L, t=-0.380, P=0.706]. Conclusion Dialysate containing calcium 1.5mmol/L can achieve effective anticoagulation with safer blood free calcium concentration, and it may be appropriate for simplified citric acid anticoagulant hemodialysis.
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