低分子肝素用于血液透析抗凝

Anticoagulation effect of a single dose low molecular weight heparin in the patients on maintaince hemodialysis-A clinical trial of 26 cases

本文使用低分子肝素(Fragmin)作为抗凝剂一次性给药进行血液透析.观察了26例患者294次血液透析的疗效。结果显示,使用 Fragmin 抗凝时,透析器重复使用平均4.5次,未见明显透析器内及透析管路凝血;用药前后凝血酶原时间、凝血酶原活动度、部分凝血活酶时间、血红蛋白、血小板计数无明显变化(P>0.05);每次用药前后血浆抗因子 Xa 活性变化显著(P<0.001);未发现严重出血病例。本文的结论是透析开始时,一次性给予 Fragmin 行 HD 抗凝,安全有效、简单方便。

The anticoagulant efficacy and side ef- fects of low molecular weight heparin (Frangmin)were observed in 26 cases (male 16,female 10,age 26～65)received maintaince hemodialysis(total 294 treat- ments).All of the patients received 4 hours hemodialysis treatment(Cuprophan 1.2 m^2 dialyzer,bicarbonate dialysis),2 to 3 times a week for four weeks,and without Epo treatment.The bolus doseof 5000u (anti-Xa IU)Fragmin was given in the ve- nous side of blood line at the begining of dialysis without maintaince heparine supply during the dialysis session.The clot of dial- yser and the bleeding of the patients were observed and the Hb,Plt,APTT,PT and activity,SGOT were detected before and af- ter this study;plasma antifactor Xa activity was observed before administration and 15 minutes after administration(15 min)of Fragmin and 15 minutes before the end of each dialysis.There were no differences of Hb,Plt,APTT,PT+A,SGPT,SGOT be- fore and after the research.No bleeding oc- curred in the total 294 treatments.The dia- lyzer was reused 4.5 times and there was no clot in dialyzer in almost all the 26 patients except for 2 cases(7 treatments)who was in high risk of coagulation before this Study.The plasma antifactor Xa activity were 0.04+/-0.02 and 1.52+/-0.38 (U/ml)before and 15 min respectively(P <0.001);The range of antifactor Xa ac- tivity was 0.44+/-0.18 through 0.54+/ -0.24(U/ml)at the end from the first through the 12th dialysis.There were sig- nificant differences in antifactor Xa activity between the before and the end(P< 0.001),as well as the 15 min and the end (P<0.001)of treatment.Conclusions:① A single bolus dose of Fragmin using in the maintaince hemodialysis patients was effec- tive and safe;②The antifactor Xa activity was not changed from the first through the 12th dialysis in 15 min before the end of dialysis.