农药中毒患者第二次血液灌流抗凝方法的研究

Method of anticoagulation at second time of blood perfusion for patients with pesticides poisoning

目的探讨农药中毒患者第二次血液灌流时的抗凝方法，在保证抗凝效果的同时，减少患者出血发生率。方法将44例连续两次血液灌流的农药中毒患者随机分为两组，对照组两次和观察组第一次血液灌流时均常规肝素化抗凝，观察组第二次采用低分子肝素钙结合小剂量盐水持续稀释法无肝素灌流。比较两组治疗后凝血、出血情况和两组治疗前后凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、血小板（PLT）的变化。结果两组治疗后均无Ⅱ级以上凝血，观察组治疗后出血1例，对照组治疗后出血7例，两组比较有显著差异（P〈0．01），两组治疗后TP、APTT、TT比较有显著性差异（P〈0.01）PLT也有显著性差异（P〈0．05），两组治疗后比治疗前门、APTT、TT、PLT均有显著性差异（P〈0．01）。结论低分子肝素钙结合小剂量盐水持续稀释法无肝素灌流具有抗凝效果好、出血发生率低等特点，是一种安全、有效、方便的抗凝方法。

Objectives To investigate the method of anticoagulation at second time of blood perfusion for the patients with pesticides toxicology. Methods 44 patients with pesticides poisoning of continuing blood, perfusion for two times were randomly divided into two. groups. The control group had been routinely, heparinized for anticoagulation for 2 times ,and the observation group was routinely heparinized for one time for anticoagulation during the first blood perfusion, A low molecular heparin calcium combined with small dose of saline as a continuous dilution method without heparin perfusion at second time of blood perfusion was given to the observation group. Comparison of the changes in blood coagu- lation, bleeding condition and the prothrombin time （PT） of the two groups before and after treatment, activating part of the prothrombin time （APT＇F）, thrombin time （TT） and change of the blood platelet （PLT）. Results There was no above Ⅱ grade coagulation in two - group after treatment. One case of bleeding occurred in observation group after treatment. 7 cases of bleeding occurred in control group after treatment. There is significant difference in the comparison of the two group（ P 〈 0.01 ）. The comparison of PT, APTT and T＇F in two groups after treatment were significant difference （P 〈 0.01 ） PLT was also significant difference （P 〈 0.05 ） There was significant difference on PT, APTT and TT and PLT in two groups after and before treatment But the differences after treatment were more apparent than before treatment （P 〈 0.01 ）. Conclusion Low molecular heparin calcium combined with small dose saline as a continuous dilution method without heparin perfusion has a good result of anticoagulation and the characteristics of low bleeding rate, being a safety, efficiency and convenient anticoagulation method.