肾综合征出血热连续性肾脏替代治疗及肝素抗凝的应用研究

Applied Research of Continuous Renal Replacement Therapy and Heparin Anticoagulation in Patients with Hemorrhagic Fever and Renal Syndrome

目的分析肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)患者连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)及CRRT中肝素抗凝的应用情况。方法对我中心2008年1月—2012年8月住院的346例HFRS患者的临床资料进行回顾性分析。结果轻、中型患者均未行CRRT。危重型患者CRRT治疗率和重叠期时初始CRRT治疗率明显高于重型,而间断性血液透析治疗率低于重型患者(P<0.01,P<0.05)。11例重型患者和48例危重型患者行CRRT,70次肝素抗凝中有16次考虑抗凝诱发加重机体出血,2次考虑抗凝后期出现管路凝血;33次无肝素化治疗中均未诱发加重机体出血,有4次在治疗后期出现管路凝血。结论 CRRT已广泛应用于危重型HFRS患者的救治,应结合疾病自身的临床特点,合理地选择肝素抗凝与无肝素化治疗策略。

Objective To analyze the continuous renal replacement therapy （CRRT） and heparin anticoagula- tion in application of patients with hemorrhagic fever and renal syndrome （HFRS）. Methods Clinical data of 346 inpa- tients with HFRS during January 2008 and August 2012 was retrospectively analyzed. Results CRRT was not applied in patients with mild or moderate-type HFRS. Compared with those in severe-type patients, the CRRT cure rate and incipi- ent overlapping phases of CRRT cure rate were significantly higher, while the cure rate of intermittent hemodialysis was lower in critical-type patients （P 〈 0. O1, P 〈 0.05 ）. Eleven severe-type patients and 48 critical-type patients with HFRS were treated with C RRT, and of the 70 times of C RRT treated with heparin antieoagulation, 16 times of hemorrhage were considered of being induced by heparin anticoagulation, and 2 times of channel blood clotting were considered in later stage of anticoagulation; of the 33 times of CRRT without heparinization, there were 4 times of channel blood clotting. Conclusion CRRT has been widely used in critical-type patients with HFRS. The heparin anticoagulation and no anti- coagulant strategies should be rationally used according to the clinical characteristics of the disease.