联机血液透析滤过前后交替稀释法对肝素用量的影响

The effect of online hemodiafiltration dilution method on dosage of heparin

目的比较联机血液透析滤过前后交替稀释法和单纯后稀释法对肝素用量的影响。方法对33例行血液滤过的患者,进行自身对照研究。对比前后交替稀释法与单纯后稀释法血液透析滤过完成情况、肝素用量、透析器及管路凝血情况和每次透析效果(Kt/V值)。结果血液透析滤过完成情况:前后交替稀释法完成率为100%,单纯后稀释法为81.8%,差异有显著性(P<0.05),肝素用量:前后交替稀释法比单纯后稀释法减少了50%。透析器‖级以上凝血:单纯后稀释法为19%,前后交替稀释法没有Ⅱ级以上凝血发生,两种方法比较,差异有统计学意义(P<0.05);Kt/V值:前后交替稀释法为1.29±0.12,单纯后稀释法为1.28±0.10,无统计学意义(P>0.05)。结论血液透析滤过采用前后交替稀释法与单纯后稀释法相比,在保证透析效果的前提下,可以减少肝素用量,减少透析器凝血事件的发生,提高了血液透析滤过的完成率。

Objective To compare the effect of the online hemodiafiltration dilution method with the simple dilution method on the dosage of heparin.Methods 33 hemofiltration patients for the self-control study were compared the effect of the online hemodiafiltration dilution method with the simple dilution method on the hemodiafiltration completion,the dosage of heparin,clotting of the dialyzer and tubing and the effect of dialysis（Kt/V values）.Results The completion of online hemodiafiltration dilution method was 100%,while the simple dilution method was 81.8%,there was a significant difference.The dosage of heparin with online hemodiafiltration dilution method reduced by 50% than the simple dilution method.The dialyzer clotting above the level Ⅱwith the simple dilution method was 19%,while there was no dialyzer clotting above the level Ⅱwihe the online hemodiafiltration dilution method,the difference was statistically significant（P0.05）.Kt/V values of online hemodiafiltration dilution method was 1.29±0.12,while the simple dilution method was 1.28±0.10,not statistically significant.Conclusion Compared with the simple dilution method,online hemodiafiltration dilution method can ensure the effect of dialysis,reduce the dosage of heparin,decrease the incidence of dialyzer clotting and improve the completion rate of hemodiafiltration.