不同抗凝方法在血液灌流急救中的临床应用研究

The Clinical Research of Different Anticoagulation Approach in Hemoperfusion Emergency Treatment

目的比较普通肝素和低分子肝素在血液灌流急救中的应用,探讨低分子肝素用于血液灌流的可行性及优势。方法回顾我中心76例药物毒物中毒行血液灌流的患者,共行灌流120例次,70例各为1次,10例各为5次（为百草枯中毒）;其中应用普通肝素（HS）组59例次,应用低分子肝素（LMWH）组61例次。分别观察两组灌流前、灌流开始后30 min、灌流2h结束时的凝血酶原时间（PT）、部分凝血酶原时间（APTT）、凝血酶时间（TT）;灌流器及管路凝血情况及病人临床出血征象。结果 HS组PT、APTT及TT在灌流开始30 min、灌流结束时较LMWH组延长,差异有统计学意义（P〈0.05）。HS组灌流器及管路0级凝血57例（96.61%）,Ⅰ级凝血1例（1.69%）,Ⅱ级凝血0例,Ⅲ级凝血1例（1.69%）;LMWH组0级凝血60（98.36%）,Ⅰ级凝血1（1.64%）,Ⅱ级凝血0例,Ⅲ级凝血0例。HS组出现2例鼻出血、3例血尿、1例胃出血、2例颈内静脉导管穿刺处出血;LMWH组出现0例鼻出血、0例血尿、1例胃出血、0例颈内静脉导管穿刺处出血。结论在血液灌流中低分子肝素比普通肝素更有效、安全、方便,值得推广应用。

Objective This article is to investigate the feasibility and ascendancy of Low Molecular Heparin through comparing the application of heparin with Low Molecular Heparin in Hemoperfusion Emergency Treatment.Methods 76 patients with intoxation who accepted 120 hemoperfusion was reviewed,70 patients accepted once and 10 patients accepted 5 times（parquat）;of which 59 received heparin（HS Group） and 61 received Low Molecular Heparin（LMWH Group）.PT,APTT,TT;periph blood clotting and the hemorrhage signs of patients were observed.Results The PT,APTT,TT of HS Group was obvious longer than LMWH Group（P0.05）.Periph blood clotting of HS Group： 0 grade 57 times（96.61%）,Ⅰ grade once（1.69%）,Ⅱ grade 0,Ⅲ grade once（1.69%）;LMWH Group： 0 grade 60 times（98.36%）,Ⅰ grade 1（1.64%）,Ⅱ grade 0,Ⅲ grade 0.There are 2 nose bleed,3 blood urine,1 gastrorrhagia and 2 venous duct hemorrhage in HS Group;There are 0 nose bleed,0 blood urine,1 gastrorrhagia and 0 venous duct hemorrhage in LMWH Group.Conclusion In Hemoperfusion,Low Molecular Heparin is valider,safer,more convenient than heparin.Low Molecular Heparin should be extended and utilized.