低分子肝素在肾综合征出血热急性肾功能衰竭血液透析中的作用

A low molecular weight heparin for anticoagulation during hemodialysis in patients with hemorrhaglc fever with renal syndrome

目的 比较低分子肝素(LMWH)与普通肝素(SH)在肾综合征出血热(HFRS)伴急性肾功能衰竭(ARF)患者血液透析(HD)中的疗效和安全性。方法 51例HFRS患者随机分为二组,分别进行LMWH和SH抗凝HD各79和80例次。治疗中观察患者出血情况有无加重,透析器的颜色和残血量,体外循环管道压力及有无凝血;测定活化部分凝血酶时间(APTT)与凝血酶时间(TT)并与正常值对照;测定透析两小时尿素氮、肌酐清除率(BUN、CCr)。结果 159例次血液透析均能顺利进行,无出血加重及凝血现象,LMWH组有10例次(12％),SH组有12例次(15％)静脉侧、透析管路静脉室有轻度凝血。LMWH组APTT、TT在透析2小时轻度延长,4小时后基本恢复到治疗前水平,与正常对照值相近;而SH组、APTT、TT在透析2小时、4小时均有明显延长。LMWH与SH两组间透析二小时透析器BUN、CCr无明显差异。结论 使用LMWH后APTT、TT无明显延长,引起出血危险性低,是HFRS伴ARF血液透析的理想抗凝剂。

Objective To evaluate the efficacy and safety between low molecular weight heparins(LMWH) and standard heparin(SH) in hemodialysis(HD) patients of Hemorrhagic fever with renal syndrome(HFRS).Mettiods Fifty - one HFRS patients were randomly divided into two groups.LMWH were used in 79 dialysis procedures and SH were used in 80 dialysis procedures.Bleeding complication of the patients,the visual aspect and the pressure of die extracor-poreal circuits were observed.APTT and TT,BUN and CCr on the second hour of the dialysis session were measured.Results No bleeding complications and anaplylaxis were seen in both groups,but there was alight thrombus formation occurred ten times (12%) of LMWH and twelve times (15%) of SH in the extracorporeal circuit.APTT and TT were marginally prolonged by the LMWH at 2hr and basically returned to predialysis levels at 4hr,but they were markedly prolonged by SH at 2hr and 4hr.The clearance of urea and creatinine were comparable in both groups after 2hr of the sessions.Conclusion APTT and TT were not significant prolonged by LMWH after dialysis.LMWH was effective,safe anticoagulation for die patients with HFRS.