低分子肝素在出血倾向血透患者中的应用

The Application of Low Molecular Weight Heparin in Hemodialysis Patients with Hemorrhage Risks

目的 探讨低分子肝素（ｌｏｗ ｍｏｌｅｃｕｌａｒ ｗｅｉｇｈｔ ｈｅｐａｒｉｎ，ＬＭＷＨ）在有出血倾向的血透患者中的应用。方法 根据ＳＷＡＲＴＺ分级，选择中、高危出血倾向患者１２０例，其中Ａ组９３例血透患者用ＬＭＷＨ抗凝，剂量为０．４～０．５ｍｌ／次；Ｂ组２７例，用血仿膜透析及小剂量标准肝素抗凝，首剂为１２５０Ｕ。同时观察临床表现、血清肌酐、尿素和凝血活酶时间（ＫＰＴＴ）。结果 Ａ、Ｂ两组病人均完成４～５ｈ的血透，透析器及透析管道的凝血情况均为０～Ⅰ级，血透效果两组相比无显著差别（Ｐ＞０．０５），Ａ组病人血透期间无１例出现出血症状明显加重，Ｂ组中有３例出血现象略有加重，Ａ组透析２ｈ与透析后ＫＰＴＴ值较透析前无显著延长（Ｐ＞０．０５），而Ｂ组透析２ｈ时ＫＰＴＴ值为６９±２４ｓ，较透析前４５±１５ｓ显著延长（Ｐ＜０．０５）。结论 ＬＭＷＨ具有良好的抗凝效果，保证透析顺利进行，同时不加重出血，较适用于中、高危出血倾向的血透患者。

Objective The aim is to discuss the application of low molecular weight heparin (LMWH) in hemodialysis patients who have the hemorrhage risks. Methods 120 hemodialysis pa- tients who had middle or high risk of hemorrhage were divided into two groups. According to the SWARTZ classification there were 93 patients in group A, who were dialyzed with LMWH in the dosage of 10000 - 12500AXalCU; The others were in group B, who were dialyzed with hemophane and low dosage standard heparin in the dosage of 1250μ at beginning, the 250μ per hour untill an hour before the end of hemodialysis. The clinical manifestations, serum creatinine, urea and KPTT were observed. Results Both two groups had 4-5 hours hemodialysis. Their dialyzers and pipelines were in 0 - I degree coagulation. There was no significant difference on the efficacy of hemodialysis between two groups. In group A, none had whose hemorrhage symptom aggravated, but 3 patients in group B had the symptom aggravated. In group A, there was no significant difference in KPTT value before, at two hours and after dillysis. In group B, the KPTT value at two hours was 69 ± 24 seconds, which was sig- nificant longer than that of pre - hemodialysis, which was 45 ± 15 seconds(P < 0.05 ). Conclusion Low moecular weight heparin(LMWH) is an effective anticoagulator on hemodialysis, it dosen't aggravate the hemorrhage symptom generally, therefore it is suitable for hemodialysis patients, especially those with middle or high risk of hemorrhage.