低钙透析对高凝血液透析患者凝血系统的影响

Effects of maintenance hemodialysis with low-calcium dialysis solutions on blood coagulation system in hypercoagulable patients

目的:研究低钙透析对处于高凝状态的维持性血液透析(MHD)患者凝血系统的影响。方法:根据透析液钙离子浓度,48例高凝MHD患者被随机分为3组:钙离子浓度1.25 mmol/L(Dca 1.25)的16例,1.50 mmol/L(Dca 1.5)的18例,1.75mmol/L(Dca 1.75)的14例,透析液其他成分不变。3组患者每次透析4.5 h,共透析1月。监测透析前后血小板(PLT)、活化部分凝血酶原时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)。结果:透析后Dca 1.25组FIB(5.07±0.94)g/L比Dca1.5组的FIB(6.08±1.49)g/L明显下降(P<0.05),比Dca 1.75组的FIB(5.82±0.98)g/L也明显改善(P<0.05);而Dca1.5组和Dca 1.75组的FIB比较则无显著性差异(P>0.05)。Dca 1.25组在透析前后FIB有显著性差异(P<0.01)。3组透析后PLT、APTT、PT均无明显差异(P>0.05)。结论:低钙透析能够改善维持性血透患者的高凝状态,降低出血及凝血风险。

Objective：To investigate the effects of maintenance hemodialysis （MHD） with low -calcium dialysis solutions on blood coagulation system in hypercoagulable patients. Methods： According to the serum calcium concentration, 48 hypercoagulable MHD patients were randomly divided into three groups ： 1.25 mmol/L group （n = 16）, 1.5 mmol/L group （ n = 18） and 1.75mmol/L group （ n = 14）. Other components of dialysate were invariable. The hemodialysis time was 4.5 hours every time and the observation time was one month. The platelets （PLT）, activated partial thromboplastin time （APTT）, prothrombin time （PT） and fibrinolysis （FIB） were detected before and after hemodialysis. Results： After hemodialysis, the FIB concentrations in Dca 1.25, 1.5, and 1.75 groups were 5.07 ± 0.94 g/L, 6.08 ± 1.49 g/L, and 5.82 ± 0.98 g/L respectively （P 〈 0.05, Dca 1.25 group vs other groups）. There was significant difference in the FIB concentration between pre - and post - hemodialysis in all groups （ P 〈 0.01 ）. There was no significant change in the PLT, APTT and PT levels after hemodialysis（P 〉 0.05 ）. Conclusion： The low- calcium dialysis could improve hypercoagulability state and reduce the risk of hemorrhage for hypercoagulable MHD patients.