低分子量肝素在急性肾衰竭诱导性血液透析中的应用

Application of low molecular weight heparin in induced hemodialysis during acute renal failure

目的观察低分子量肝素在诱导性血液透析中抗凝的作用和对出血的影响。方法2004年1月至2006年1月,急性。肾衰竭首次血液透析的108例患者,普通肝素(UFH)组52例和低分子量肝素(LMWH)组56例。对透析器和管路凝血、颈静脉置管处伤口出血情况及部分凝血活酶时间(aPTT)和血浆抗因子X a活性(AF X a)作回顾性分析。结果诱导性血液透析中合适的LMWH抗凝与UFH差异无统计学意义(P>0.05)。用LWMH后手术置管伤口出血较UFH组明显减少(P<0.01),透析前、透析开始0.5 h、2 h、3 h、4 h、和透析结束1 h,UFH组aPTT,TT显著长于LWMH组(P<0.01),LWMH组抗FX a活性较UFH组显著增加(P<0.01)。结论低分子肝素与普通肝素产生相同抗凝效果时对出血影响较小,更适用于手术后诱导性血液透析的抗凝,值得临床推广。

Objective To observe the anticoagulant effect of low molecular weight hepaxin on induced hemodialysis in patients with acute renal failure. Method One hundred and eight patients with acute renal failure treated with induced hemodialysis were randomly divided into low molecular weight heparin （LMWH） group and unfractionated heparin （UFH） group. A bolus dise of UFH was given at first and then maintained by continuous infusion in UFH group, whereas a single bolus dose of LMWH with 2000AFⅩa IU to 4000AFⅩa IU in LMWH group. Results Anticoagulant effect between LMWH and UFH did not show significant discrepancy during induced hemodialysis. The bleeding from internal jugular vein catheter increased in the UFH group much more than that in the UFH group was significantly higher than that in the LMWH group. Anti-FXa blood levels were significantly higher in LMWH group than in UFH group. Conclusions LMWH has minor intluence on aPTT and TT, while its anticoagulation effect approximates to that of UFH. LMWH represents a realistic alternative agent UFH in acute renal failure induced hemodialysis.