低分子肝素在血液透析滤过中不同给药方式的分析

Anticoagulation effect of low molecular weight heparin on hemodiafiltration by different forms of administration

目的 观察在血液透析滤过中,相同剂量的低分子肝素（LMWH）经动脉端及静脉端两种不同方式给药的抗凝效果.方法 选择24例进行血液透析滤过的尿毒症患者,随机分为动脉端给药组和静脉端给药组,其中12例在治疗开始时经动脉端（血滤器前）给予LMWH抗凝;另12例在治疗开始时经静脉端（血滤器后）给予LMWH抗凝.治疗开始前全部患者检测活化部分凝血酶时间（APTT）,治疗开始后2 min、5min、1 h、2 h、3 h分别检测透析液及血浆LMWH浓度,并于治疗开始后1、2、3 h检测APTT.结果 静脉端给药组1 h血浆LMWH浓度高于动脉端给药组[（0.457±0.073）U/ml与（0.217±0.053）U/ml,t=9.702,P=0.001];透析液LMWH浓度极低且组间及时间段间差异均无统计学意义（P均＞0.05）;2组相应的APTT及滤器残留差异亦无统计学意义（P均＞0.05）.结论 2组不同的给药方式虽造成了LMWH血浆浓度的差异却没有影响血液透析滤过的抗凝效果,与透析膜吸附低分子肝素有关.

Objective To study the anticoagulation effect of low molecular weight heparin （ LMWH） on hemodiafiltration by different forms of administration. Methods Twenty-four uremic patients undertook hemodiafiltration were divided into ia and iv group randomly, acecepted single injection of LMWH. LMWH was administered to 12 patients by arterial injection （ predialyzer）, while in the other 12 patients by venous injection （postdialyser）. The APTT were measured before treatment and at 1 h,2 h,3 h time points after treatment in all patients. The dialysis fluid and blood levels of LMWH were measured at 2 minutes,5 minutes,1 h,2 h,3 h time points after the treatment started. Results The LMWH levels during hemodiafiltration were significantly higher in iv group than ia group （0.457 ± 0.073 ） U/ml vs. （0. 217 ± 0. 053 ） U/ml, t = 9. 702, P = 0. 001 ）. However there were no significant APTT, dialyzer residual substance differences between two groups （P 〉 0. 05 respectively ）Conclusions Different ways of drug administration resulted in significantly different blo＇od levels of LMWH, but did not affect the anticoagulant effect during hemodiafiltration, which would be related to LMWH absorption on dialysis membrant.