抗Ⅹa因子活性监测在慢性肾功能衰竭患者维持性血液透析中精准抗凝的研究

Study on the precise Anticoagulation of anti-Factor Xa Activity monitoring in Maintenance Hemodialysis treatment of Patients with Chronic renal failure

目的为慢性肾功能衰竭维持性血液透析患者提供精准抗凝的监测手段,避免抗凝不足带来的透析器及管路凝血,血栓形成风险以及抗凝过量引起的出血事件。方法选取2020年1月至2020年12月在新疆医科大学第六附属医院血液透析室维持性血液透析治疗的患者,共计80例,根据患者抗Ⅹa因子活性分为3组:A组为抗因子Ⅹa活性<0.4IU/ml,B组为0.4IU/ml≤抗因子Ⅹa活性<1.0IU/ml,C组为抗因子Ⅹa活性≥1.0IU/ml。记录是否因透析器凝血而不能完成预定治疗时间。观察透析器、管路凝血情况。检测比较各组患者血红蛋白、血小板、血浆白蛋白、血清钙、磷、PTH、透析充分性指标。结果A组患者治疗结束24h内出血发生例数为8例,发生率为16%,透析器等级≥Ⅱ级例数8例,发生率16%,B组患者治疗结束24h内出血发生例数为8例,发生率为16%,透析器等级≥Ⅱ级例数8例,发生率16%,C组患者治疗结束24h内出血发生例数为8例,发生率为16%,透析器等级≥Ⅱ级例数8例,发生率16%,(P<0.05)。A组患者透析充分性达标(KT/V值≥1.2)例数10例,B组患者透析充分性达标例数10例,C组患者透析充分性达标例数10例,(P<0.05)。结论维持性血液透析患者抗Ⅹa因子活性在0.4IU/ml-1.0IU/ml范围之间安全有效,且能保证透析充分性。血液透析中使用低分子肝素钠抗凝的患者可以通过监测抗Ⅹa因子活性达到精准抗凝。

Objective To provide accurate anticoagulation monitoring methods for chronic renal failure patients with maintenance hemodialysis,and avoid the risk of coagulation in dialyzers and pipelines,thrombosis and bleeding events caused by excessive anticoagulation.Methods From January 2020 to December 2020,80 patients with maintenance hemodialysis in the hemodialysis room of our hospital were selected and divided into three groups according to the anti factor Xa activity:group A:anti factor Xa activity<0.4 IU/ml;group B:0.4 IU/ml≤anti factor Xa activity<1.0 IU/ml;group C:anti factor Xa activity≥1.0 IU/ml.Record whether the scheduled treatment time cannot be completed due to coagulation of dialyzer.Observe the coagulation of dialyzer and pipeline.Hemoglobin,platelet,plasma albumin,serum calcium,phosphorus,PTH,dialysis adequacy index were detected and compared in each group.Results There were 8 cases of bleeding within 24 hours after treatment in group A(16%),8 cases with dialyzer grade≥Ⅱ(16%),8 cases with dialyzer grade≥Ⅱ(16%),8 cases with dialyzer grade≥Ⅱ(16%)and 8 cases with dialyzer grade≥Ⅱ(16%)within 24 hours after treatment in group B,and 8 cases(16%)in group C There were 8 cases with dialyzer grade≥gradeⅡ,the incidence was 16%(P<0.05).There were 10 patients in group A(kt/V≥1.2),10 in group B and 10 in group C(P<0.05).Conclusion The anti factor X A activity in maintenance hemodialysis patients is safe and effective in the range of 0.4 iu/ml-1.0 iu/ml,and can ensure the adequacy of dialysis.Patients who use low molecular weight heparin sodium anticoagulation in hemodialysis can achieve accurate anticoagulation by monitoring the activity of anti factor Xa.