血液透析患者凝血功能变化及因素分析

Changes of coagulation function and factor analysis for patients taking hemodialysis

目的探讨血液透析治疗对患者凝血功能的影响及原因分析。方法选取我院2012年1月~2014年4月共68例进行维持性血液透析患者透析前后的血液样本,采用流式细胞术检测血小板表面P-选择素。用间接酶链免疫吸附试验检测超敏C反应蛋白、内皮血管性血友病因子和D-二聚体。并通过对患者的观察、病例资料的整理以及对血透后透析器血容量测量等,回顾性分析血液透析患者发生凝血功能变化的原因及分析。结果经治疗后患者均痊愈出院,治疗后PT和FIB值明显少于治疗前（P〈0.05）,APTT和TT值较治疗前差异无统计学意义（P〉0.05）。D-二聚体治疗前阳性率50%,治疗后为0,差异有统计学意义（P〈0.05）。血液透析后患者的血小板表面P-选择素、超敏C反应蛋白、内皮血管性血友病因子、D-二聚体结果明显高于透析前,差异有统计学意义。影响患者发生凝血功能变化的因素包括自身体质、医生评估不到位、抗凝不当、肝素用量不足及护士操作技术不当。结论医护人员应加强抗凝知识的学习,提高对血液透析患者凝血状态的评估和检测,并及时合理提供抗凝方案,熟练操作技术,与此同时,虽然在治疗中应用肝素,但患者仍可能处于高凝状态,因此定期进行凝血指标的监测可有效减少血液透析中凝血的发生。

Objective To explore the effects of hemodialysis on patients＂ coagulation function and to analyze its rea- sons. Methods Blood samples of 68 patients before and after hemodialysis who took maintenance hemodialysis in our hospital from January 2012 to April 2014 were selected. Flow cytometry was applied to test P-selectin on platelet sur- face. Indirect enzyme linked immunosorbent assay was applied to test ultra-sensitive C-reactive protein, endothelial von Willebrand factor and D-dimer. Through the observation on patients, arrangement of patient data, and measurement of dialyzer blood volume after hemodialysis, reasons and analysis for changes of coagulation function for patients taking hemodialysis were retrospectively analyzed. Results All patients were discharged from hospitals after the treatment, and PT and FIB values after the treatment were significantly lower than those before the treatment （/9〈0.05）. APTF and TI＇ values were not statistically different from those before the treatment （P〉0.05）. Positive rate of D-dimer was 50% before the treatment and 0.0% after the treatment, and the difference compared before and after the treatment was statistically significant （1~〈0.05）. Results of P-selectin on platelet surface, ultra-sensitive C-reactive protein, endothelial von Wille- brand factor and D-dimer after hemodialysis were significantly higher than those before hemodialysis, and the differ- ences were statistically significant. Factors affecting changes of patients＂ coagulation function included individual health quality, doctors＂ inaccurate assessment, inappropriate anti-coagulation, insufficient usage of heparin and inappropriate operation techniques by nurses. Conclusion Medical staff should enhance their knowledge of anti-coagulation, improve the assessment and testing of coagulation status for patients taking hemodialysis, provide anti-coagulation protocol timely and properly, and practice operation techniques. Meanwhile, although heparin is used during treatment, patients may still be highly coagulated. Therefore, regular monitoring of coagulation indicators is able to effectively reduce co- agulation during hemodialysis.