低分子肝素在急性中毒血液灌流中的应用

Application of low molecular heparin to hemoperfusion for acute poisoning

[目的]观察低分子肝素作为抗凝剂在急性中毒血液灌流中的效果。[方法]将浙江省临海市第二人民医院2008年11月至2013年12月收治的急性中毒患者随机分成普通肝素组和低分子肝素组,每组60例,观察并比较两组血液灌流前后凝血功能(APTT、PT、TT)、血小板(PLT),灌流器及管路凝血、机体出血情况。[结果]低分子肝素组治疗前后PLT、APTT、PT、TT无明显变化(P均>0.05),普通肝素组治疗后PLT减少,APTT、PT、TT延长,差异均有统计学意义(P均<0.05)。管路凝血发生率:普通肝素组11.67%,低分子肝素组1.67%;出血发生率:普通肝素组18.33%,低分子肝素组5.00%。组间比较差异均有统计学意义(P均<0.05)。[结论]低分子肝素在血液灌流时抗凝作用强而不易引起出血,是首选抗凝药物,并且无需在灌流后常规做凝血功能检测。

[Objective] To observe the effect of low molecular heparin as an anticoagulant on hemoperfusion for acute poisoning. [Methods] Patients with acute poisoning treated in the Second People＇s Hospital of Linhai City from November 2008 to December 2013 were divided into unfractionated heparin（ UH）group and low molecular heparin（ LMH） group,with 60 patients in each. Before and after hemoperfusion,the blood coagulation function（ APTT,PT,and TT）,platelet（ PLT）,perfusion apparatus,catheter blood coagulation and bleeding of the patients were observed and compared between the two groups. [Results]Before and after treatment,PLT,APTT,PT and TT of the patients in LMH group were not of significant difference（ all P 0. 05）. After treatment,PLT decreased as well as APTT,PT,and TT prolonged among the patients in UH group,and the differences were statistically significant（ all P 0. 05）. The incidence of catheter coagulation was 11. 67% in UH group and 1. 67% in LMH group. The incidence of bleeding was18. 33% in UH group and 5. 00% in LMH group. The differences between the two groups were statistically significant（ all P 0. 05）. [Conclusion] Low molecular heparin with stronger anticoagulation activity does not cause bleeding easily in hemoperfusion. It is the preferred anticoagulant,and the conventional coagulation test after hemoperfusion is not necessary.