抗Xa因子在日间CRRT低分子肝素抗凝监测中的临床应用

Anticoagulant monitoring of anti-Xa factor in daily CRRT using low molecular weight heparin

关键词:  低分子肝素  抗Xa因子  APTT  CRRT

Key words:  low molecular weight heparin  anti-Xa factor  APTT  CRRT

摘要:

目的　探讨抗Xa因子在日间连续性肾脏替代治疗（CRRT）低分子肝素抗凝监测中的临床应用。方法　选择危重症慢性肾脏病5期进行日间CRRT治疗的患者62例，治疗过程中应用低分子肝素抗凝，分为抗凝未达标组、抗凝达标组和抗凝超标组。测定血红蛋白、血小板、抗凝血酶III、基础血肌酐值、基础APTT值，对治疗1 h抗Xa因子值、治疗1 h以及结束时APTT及肌酐下降率进行监测。结果　抗Xa因子三组间比较，差异均有统计学意义，P<0.05。抗凝达标组抗Xa因子为(0.62±0.37)IU/mL。1 h APTT抗凝未达标组与超标组比较，差异有统计学意义，P<0.05；肌酐下降率抗凝未达标组与其他两组比较，差异均有统计学意义，P<0.05。结论　抗Xa因子为（0.62±0.37）IU/mL时提示治疗安全、有效；抗Xa因子与APTT相比较，抗Xa因子对临床出血事件、血栓形成提示更有效。

Abstract:

Objective　 To explore the clinical application of anti-Xa factor monitoring anticoagulation of low molecular weight heparin (LMWH) in daily CRRT. 　Methods　 Totally 62 critically ill patients were selected, who had stage 5 chronic kidney disease and received daily CRRT with low molecular heparin anticoagulation in the treatment. The patients were divided into 3 groups, including below-standard anticoagulation group, standard anticoagulation group, and above-standard anticoagulation group. Serum levels of hemoglobin, platelet, antithrombin III, basic serum creatinine, and basic APTT were measured. Anti Xa-factor at 1 hour and APTT at 1 hour and the end of treatment creatinine rate descending were using for monitoring anticoagulant. 　Results　 Age, hemoglobin, platelet, creatinine and basic APTT values among the 3 groups were similar (P>0.05). Anti-Xa factor was significantly different among 3 groups (P<0.05) with anti-Xa factor in standard anticoagulation group (0.62±0.37) IU/mL. One hour APTT was significantly different between below-standard and above-standard anticoagulation groups (P<0.05). The creatinine reduction rate in below-standard anticoagulation group was significantly different compared to the other two groups (P<0.05). 　Conclusion　 When anti-Xa factor reaches the level of (0.62±0.37) IU/mL, it suggests that the treatment is safe and effective. Compared with APTT, anti-Xa factor is more effective for evaluating clinical bleeding events and thrombosis.