出血倾向病人血液净化治疗中低分子肝素的应用

LOW MOLECULAR WEIGHT HEPARIN FOR PATIENTS WITH A TENDENCY OF HEMORRHAGE DURING HEMODIALYSIS

①目的 探讨出血倾向病人在血液净化治疗中使用低分子肝素对其出血危险性的影响。②方法将 49例有出血倾向的透析病人随机分为低分子肝素 (LMWH)组和小剂量肝素组 (对照组 ) ,分别观察透析后有无再出血、出血停止并吸收时间、伤口愈合时间以及透析结束后穿刺点压迫时间、体外循环和透析器复用情况。并测定第 1次透析前后血小板 (BPC)、凝血酶时间 (TT)、部分凝血活酶时间 (APTT)。③结果 LMWH组与对照组相比 ,再出血率明显降低 (χ2 =4.0 5 ,P <0 .0 5 ) ,出血停止并吸收时间及透析后穿刺点压迫时间明显缩短 ,透析器复用次数明显多于对照组 (t=2 .14～ 4.44 ,P <0 .0 5 ) ,而体外循环凝血情况明显优于对照组 (uc=2 .47,P <0 .0 5 )。LMWH组透析前后凝血指标无明显变化 ,而对照组TT ,APTT则明显延长 (t =2 .2 3,6 .36 ,P <0 .0 5 )。

Objective\ To observe the risk of hemorrhage in using low molecular weight heparin( LMWH) during hemodialysis in patients with a tendency of hemorrhage.\ Methods\ 49 patients, with a risk of hemorrhage, undergoing hemodialysis were divided into two groups:LMWH group and small dose heparin group(control group) .We observed the incidence of hemorrhage,the time of bleeding cessation and absorption,the healing time, and the time of pressing on the injection points when the dialysis was completed as well as extracorporeal circulation and reutilization of dialyzer. BPC, TT and APTT , before and after the first dialysis, were measured in both groups.\ Results\ The probability of re bleeding for LMWH group decreased dramatically compared with the control group( χ 2=4.05, P <0.05). The time of bleeding cessation and absorption, the pressing time of puncturing points were significantly shorter in LMWH group as compared with those for the control group and the reutilization of dialyzer was significantly more than that of the control group( t=2.14-4.44, P <0.05). And the extracorporeal circulation was significantly better for LMWH group than that for the control group( u c=2.47, P <0.05). TT, APTT were significantly prolongated after hemodialysis for control group while there were no obvious variations for LMWH group( t=2.23, 6.36, P <0.05).\ Conclusion\ LMWH is more advisable than small dose of heparin for patients with a risk of hemorrhage undergoing hemodialysis.