血液透析中应用低分子量肝素的交叉对照、随机、开放、多中心临床研究

Low molecular weight heparin in chronic hemodialysis

目的比较低分子量肝素（Fragmin）与普通肝素（UFH）在血液透析中的抗凝疗效。方法100例慢性维持性血透患者（CHD）通过自身对照，按不同顺序给予Fragmin和UFH各4次作为血液透析抗凝剂，观察透析器凝血，透析器对尿素氮、肌酐清除效力，监测抗Xa活性及白陶土部份凝血活酶时间（KPTT），人工压迫止血时间。结果与UFH相比，Fragmin抗Xa活性明显高于UFH，而对KPTT影响不明显；两种肝素均应用常规剂量时，用Fragmin的透析器对尿素氮、肌酐的清除效力明显优于UFH，压迫止血时间缩短。结论Fragmin的抗凝效果与UFH相似，在血液透析中应用能保证透析效果而不增加出血危险。

To investigate the safety and efficiency of LMWH(Fragmin)in chronic hemodialysis. Methods An open,randomized, cross covered, multicenter trial was made. One hundred Patients on CHD were given a single injection of 5000anti-XaU in comparison with unfractionated heparin(UFH). All Patients were randomized into UFH and LMWH in 4times HD or alternation. Results The anti-factor Xa activity was significantly higher in LMWH than that in UFH,whereas KPTT was significantly longer in UFH than that in LMWH group. There was no diffence of dialyzer coagulated fibers or the decrease of dialyzer total blood compartment volumes between two groups. The decrease Of effective urea and creatinine clearances of dialyzer evaluated after 3 the reusing was significantly less in LMWH group, the bleeding time in LMWHgroup was significantly shorter than that in UFH group. Conclusion LMWH provides an effective and safe anticoagulation effect in CHD patients.