低分子肝素在连续血液净化中抗凝作用的探讨

Clinical application of low molecular weight heparin in continuous blood purification

目的观察低分子肝素（LMWH）应用连续静脉-静脉血液滤过（CVVH）或连续动脉-静脉血液滤过（CAVH）抗凝效果和安全性，探讨LMWH在CVVH或CAVH抗凝中的最佳剂量。方法68例连续血液净化治疗患者共治疗153例次，血液净化前从静脉端给予LMWH首次剂量1000～5000U，随后立即给予LMWH（5～10U·kg^-1·h^-1）维持抗凝治疗。治疗前、治疗中每4h测定凝血酶原时间（PT）、活化部分凝血活酶时间（APTF）、纤维蛋白原（FIB）、凝血酶原时间（TT）各1次。根据患者LMWH首次剂量的不同分为3组，即A组首次剂量1000-2000U；B组首次剂量2500～3000U；C组首次剂量4000-5000U。结果各组患者治疗中4、8、12h的PT、APTT、FIB、TT与治疗前对比无差异（P〈0．05）。各组患者的平均治疗时间与滤过器使用时间无显著性差异（P〈0．05）。所有患者治疗过程中未出现出血并发症。结论LMWH用于CVVH或CAVH抗凝治疗疗效好，安全。首次剂量应用1000-2000U，即可取得良好的疗效。

Objective To investigate the anticoagulat efficacy and safety of low-molecular weight heparin （LMWH） in continuous veno-venous hemofiltration （CVVH） or continuous arterio-venous hemofiltration（CAVH）. Method 68 patients were treated 153 times. Intravenous LMWH 1 000-5 000 U were given before blood purification and then at a waintenance dose of 5-10 U·kg^-1· h^-1. Activated partial thromboplastin time（APTT） , prothromin time（PT） , thrombin time （TT） and fibriuogen（FIB） were monitored before CVVH/CAVH and every 4th during CVVH/CAVH. Based on the first dose of intravenous LMWH, patients were divided into three groups. Group A： intravenous LMWH 1 000-2 000 U, group B.. intravenous LMWH 2 500-3 000 U, group C： intravenous LMWH 4 000-5 000 U. Results No incidence of bleeding complication was encountered in all these patients. No significant differences in PT、APTT、 FIB、 TT were observed before and after treatment in three groups. There was also no difference for the mean service life of filters. Conclusions LMWH provides an effctive and safe anticoagulate effect in CVVH/CAVH, good therapeutic effect may by achieved with first does of 1 000-2 000 U of LMWH.