Raschke量表对肺血栓栓塞症抗凝指导的初步评价

目的评价以Raschke量表指导肝素治疗中国人肺血栓栓塞症时面临的问题。方法按Raschke量表调节,记录25名肺血栓栓塞症患者肝素抗凝满84h,每6h一次的APTT及肝素剂量值,描绘APTT曲线趋势图;统计不同时点抗凝达标率;至APTT稳定达标所需时间;APTT调节次数和调节波动率;每单位肝素剂量差导致的APTT差异。总结Raschke量表中与中国人不同及其忽略的影响治疗因素。结果该组患者第一个24hAPTT稳定达标率27.78%,全部不达标者占61.11%;72h后总达标率为83.32%;平均达标时间36h,需要检测APTT平均12次,APTT波动率大于74%,1U/(kg·h)肝素导致的APPT差异平均达42s。结论Raschke量表指导中国人在肝素剂量选择剂量调节幅度和剂量精确性等方面可能存在和国外不同之处;同时存在的肝素负荷量、华法林、内源性APTT和合并疾病等因素会影响抗凝达标。

Objective To evaluate confronted problems of Raschke nomogram as anticoagulation guidance in Chinese patients with pulmonary thromboembolism. Methods 25 PTE cases were guided by Raschke nomogram, the numbers of APTT and heparin dosages every 6h with 84 hours after beginning anticoagulation were recorded sequently. The APTT tendency curve was delineated. The rate to achieve APTT target in different period, time to achieve APTT target steadily, APTT adjustment frequency and APTT variation caused by each unit of heparin dosage were calculated respectively. Effected factors on therapy ofRaschke nomogram were summarized. Results The rate to achieve APTT target steadily on first 24 hours and 72 hours were 27.78% and 83.32% separately. The rate beyond APTT target on first 24 hours was 61.11%.It had need 36 hours and 12 times of APTT detection in average to achieve APTT target and lead to the fluctuation rate of APTT higher than 74%. APTr variation was 42 seconds caused by each unit of heparin dosage. Conclusion By using Raschke nomogram to treat Chinese patients, there were difference in heparin dosage selection, accuracy and adjustment degree with foreigner. Some co-existing factors such as heparin loading dosage, warfarin, endogenous APTT and complication could affect reaching APTT target.