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目的 探讨枸橼酸抗凝与无抗凝模式的持续静脉-静脉血液滤过(continuous veno-venous hemofiltration, CVVH)治疗颅内出血伴肾功能不全患者的安全性及对预后的影响.方法 收集采用枸橼酸抗凝与未采用抗凝的CVVH治疗颅内出血伴肾功能不全患者的临床资料,比较两种不同抗凝策略的CVVH治疗前后离子钙(iCa)、活化凝血时间(activated coagulation time,ACT)、纤维蛋白原(FIB)及血小板(PLT)的变化及首次CVVH治疗滤器寿命的长短,通过对患者进行7 d的生存分析,比较两种不同抗凝策略的CVVH治疗对患者预后的影响.结果 枸橼酸抗凝组血浆iCa水平下降(P<0.05),无抗凝组FIB及PLT计数显著下降(P<0.05),枸橼酸抗凝组首个滤器寿命长于无抗凝组(P<0.05),通过COX风险回归发现患者年龄、APACHE-II评分、血肿大小与患者死亡呈正相关,枸橼酸抗凝相对于无抗凝模式的 CVVH 治疗能降低患者病死率(HR=0.229,95%CI 0.123-0.431).结论 短时程(12 h)的无抗凝模式CVVH治疗对患者凝血功能影响较小,但对于长时程(7 d)进行CVVH治疗的颅内出血且伴肾功能不全的患者,选择枸橼酸抗凝可降低患者病死率,减少医疗用费.“,”Objective To investigate the safeties and impacts of CVVH therapies adopted anticoagulation with citrate or nonanticoagulant among patients suffering encephalorrhagia and renal inadequacy. Method To accumulate clini?cal datas of these kinds of patients who accepted CVVH therapies in ways of citrate anticoagulation or anticoagulation lacked. Ionized calcium (iCa) in plasma,activated clotting time(ACT),fibrinogen(FIB),platelet(PLT) are measured be?fore CVVH administered and 12 hours later after initiation according to different anticoagulate strategies. The life span of the first filters are evaluated too. By means of survival analysis within 7 days after CVVH performed,the im?pacts of different anticoagulate strategies are evaluated. Results Level of ionized calcium in plasma declined among patients accepted citrate anticoagulation for CVVH therapy,while levels of FIB and counts of PLT declined among pa?tients without anticoagulant. CVVH therapy with citrate anticoagulation may reduce mortality comparing with nonanti?coagulant useage through our COX regression mode(l HR=0.229,95%CI 0.123～0.431).Conclusions We propose that nonanticoagulation affect little with system coagulation function for short term,while citrate anticoagulation dur?ing CVVH therapy may reduce mortality for patients whom suffered from encephalorrhagia and renal inadequacy and cut down medical expense in long term.