体外无肝素连续性肾脏替代治疗的相关因素对人凝血功能的影响

Experimental Study of Influence on Coagulation During Heparin-Free Continuous Renal Replacement Therapies(CRRT)

目的体外探讨无肝素连续性肾脏替代治疗(CRRT)过程中相关因素对人凝血功能的影响。方法以健康人血样本为研究对象,等比例加入置换液、聚砜膜空心纤维后通过恒温旋转的方式体外模拟CRRT过程中相关因素对血液凝血功能的影响,根据影响因素不同实验分为碳酸氢钠、聚砜膜空心纤维及血流切应力三个组,分别检测PT、APTT及血小板计数值三个指标。结果随着碳酸氢钠浓度的增加,其对应实验小组血样本的PT、APTT及血小板计数值均较正常对照组显著有显著性(P<0.05);随着空心纤维数目的增加,对应的实验小组PT、APTT值及血小板计数值均较正常对照组显著有显著性(P<0.05);随着旋转速度的增加,对应实验小组的血小板计数值与正常对照组差异有显著性(P<0.05)。结论随着CRRT置换液中碳酸氢钠浓度、聚砜膜面积及血流切应力的改变,机体凝血功能可以受到显著影响。

[Objective]To investigate the influence of heparin-free CRRT on coagulation in vitro. [Methods]An ultraflux AV600S was ,selected and then broken by hacksaw. Polysulfone hollow fibers were separated carefully. Three groups were set up in the experiment according to different influence factors： ①Group of sodium biearbonate;②Group of polysulfone hollow fibers;③Group Of shear stress. After experiment, pH of replacement fluid with different concentration of sodium bicarbonate was tested. Blood samples were measure of PT, APTT and BPC （blood platelet count）. [Results]① Group of sodium bicarbonate： Compared with con trolled group, sodium bicarbonate could prolong the value of PT and APTT and decrease the number of plate let in the sample（ P 〈0.05）. The effect was associated with the dosage of sodium bicarbonate. ②Oroup of polysulfone hollow fibers： Compared with controlled group, polysulfone hollow fibers could decrease the value of PT, APTT and BPC（P 〈0.05）. The effect was associated with the area of polysulfone membrane. ③ Group of shear stress; Compared with controlled group, the speed of rotation had little effect on the value of PT, APTT but decreased BPC relevant to the speed（ P 〈0.05）. [Conclusion]①The influence of replacement fluid on the blood coagulation and activity of platelet is associated with the concentration of sodium bicarbonate. ②The area of polysulfone membrance has direct effect on the blood coagulation and the activity of platelet. ③The shear stress of blood stream has direct effect on the activity of platelet but little effect on the value of PT and APTT.