摘要目的:比较枸橼酸钠与低分子肝素用于有高危出血风险的血液透析患者的临床效果。方法:选取运城市中心医院2016年1月至2019年1月收治的有高危出血风险的血液透析患者110例，入组前患者均未发生出血事件。采用随机数字表法分为对照组( n＝55)、观察组( n＝55)，对照组采用低分子肝素抗凝，观察组采用枸橼酸钠抗凝，比较两组凝血功能、出血事件发生情况及临床效果。 结果:观察组未发生出血事件，对照组出血事件发生率为10.91%(6/55)，两组差异有统计学意义(χ 2＝4.407， P＝0.036)；观察组透析时血钠、血钙分别为(132.84±25.48)mmol/L、(0.87±0.12)mmol/L，均低于对照组的(148.75±26.35)mmol/L、(1.10±0.14)mmol/L( t＝3.219、9.251，均 P<0.05)；观察组体外循环凝血0级率为94.55%(52/55)，高于对照组的50.91%(28/55)，差异有统计学意义(χ 2＝24.246， P<0.05)；观察组透析时部分凝血活酶时间(APTT)、穿刺点压迫时间均短于对照组，滤器使用时间长于对照组( t＝14.404、7.899、9.677，均 P<0.05)；两组尿素氮下降率(URP)及尿素清除指数(Kt/V)、超滤量差异均无统计学意义(均 P>0.05)。 结论:与低分子肝素相比，枸橼酸钠用于有高危出血风险的血液透析患者，可减少凝血事件的发生，降低出血事件发生率。

abstractsObjective:To compare the clinical effects of citric acid and low molecular weight heparin in hemodialysis patients at high risk of bleeding.Methods:From January 2016 to January 2019, 110 hemodialysis patients with high risk of bleeding in Yuncheng Central Hospital were selected and divided into control group( n=55) and observation group( n=55) according to the random digital table method.No bleeding events occurred in the patients.The control group was given anticoagulant therapy with low molecular weight heparin, and the observation group was given anticoagulant therapy with citric acid.The coagulation function, the occurrence of bleeding events and the clinical effect of the two groups were compared. Results:There was no bleeding event in the observation group, and the incidence of bleeding event in the control group was 10.91%(6/55), the difference between the two groups was statistically significant(χ 2=4.407, P=0.036). The blood sodium and calcium levels in the observation group were (132.84±25.48)mmol/L, (0.87±0.12)mmol/L, respectively, which were lower than those in the control group [(148.75±26.35)mmol/L, (1.10±0.14)mmol/L]( t=3.219, 9.251, all P<0.05). The grade 0 coagulation rate of the observation group was 94.55%(52/55), which was higher than that of the control group [50.91%(28/55)], the difference was statistically significant(χ 2=24.246, P<0.05). In the observation group, the APTT and the compression time at the puncture point were shorter than those in the control group, and the use time of the filter was longer than that in the control group, the differences were statistically significant( t=14.404, 7.899, 9.677, all P<0.05). There were no statistically significant differences in the URP, kt/V and UF between the two groups(all P>0.05). Conclusion:Compared with low molecular weight heparin, citric acid is safe and effective for hemodialysis patients at high risk of bleeding.