局部体外肝素、无肝素及低分子肝素抗凝在有出血倾向的血液透析中的对比研究

Comparison of anticoagulation using regional heparin,heparin-free and low molecular weight heparins in hemodialysis patients with high risk of bleeding

关键词:  血液透析  抗凝  出血

Key words:  hemodialysis  anticoagulation  bleeding

摘要:

［目的］探讨局部体外肝素、无肝素及低分子肝素抗凝在有出血倾向的血液透析中应用的安全性和有效性。［方法］ 选择伴有中、高危出血倾向的血透患者22例，随机分为局部体外肝素组6例，无肝素组8例，低分子肝素组8例。观察出血情况的变化，计算eKt/V值，记录血流量、超滤量、每小时监测透析器跨膜压（TMP），观察透析器凝血程度及透析前后活化部分凝血活酶时间（APTT）和血小板计数。［结果］ 每组均行血透40例次；3组出血发生率分别为5%、5%和12.5%（P<0.05）；eKt/V值分别为1.25±0.41、1.19±0.23和1.22±0.35（P>0.05）；Ⅰ级凝血发生率分别为5%、20%和10%（P<0.05）；无肝素组超滤量、血流量和跨膜压较其他两组明显增加（P<0.05）；低分子肝素组透析前后APTT分别为 （33±4）s和（45±5）s（P<0.05），其他两组透析前后APTT和血小板无变化。［结论］局部体外肝素、无肝素和低分子肝素抗凝均能有效地应用于有出血倾向的血液透析，其中局部体外肝素抗凝是一种安全且监测方便的抗凝方式。

Abstract:

［Objective］ To assess the efficacy and safety of regional heparin,heparin-free and low molecular weight heparin (LMWH) anticoagulation in hemodialysis patients with high risk of bleeding.［Methods］ Twenty-two patients were randomized in this study and divided into three groups,six patients in regional heparin group,eight patients in heparin-free group and eight patients in LMWH group.The incidence of bleeding and the dialyser coagulation as well as Activated Partial Thromboplastin Time (APTT) and the platelet count were observed at the baseline and after hemodialysis.Hemodialysis parameters including eKt/V,vascular flow rate,ultrafiltration and transmembrane pressure (TMP) were also documented.［Results］ Every group performed forty hemodialysis sessions.The incidence of bleeding was 5%,5% and 12.5% (P<0.05) in the three groups.eKt/V value was 1.25±0.41,1.19±0.23 and 1.22±0.35 (P>0.05) respectively.GradeⅠcoagulation of dialyser was 5%,20% and 10% (P<0.05).Ultraliftration,vascular flow rate and TMP in heparin-free group significantly increased,compared with the other two groups (P<0.05).APTTs at the baseline and after hemodialysis in LMWH group were (33±4) s and (45±5) s (P<0.05).There was no change in APTT and the platelet count between the baseline and hemodialysis in the other two groups.［Conclusion］ In hemodialysis patients suffering from high risk of bleeding,the all three methods of anticoagulation show the satisfactory efficiency.In comparison with the two other groups,regional heparin anticoagulation is a safe and feasible alternative.