不同采血方法对血透半永久导管华法林抗凝者出凝血指标的影响

The effect of methods of drawing blood on coagulation time on hemodialysis patients using warfarin with permanent catheter

目的探讨维持性血液透析以颈内半永久中心静脉导管作为血管通路的患者,在使用华法林抗凝进行出凝血监测时,以来自颈内半永久中心静脉导管的血标本代替外周静脉血标本进行检验的可行性。方法选取血透半永久中心静脉导管华法林抗凝的患者30例次,对每一例次患者同一时间段抽取3个不同的血标本:1常规外周静脉抽血作为对照组,2经颈内半永久导管静脉端抽取20 ml血后留取血标本(以下称方法一),3经颈内半永久导管静脉端抽取40 ml血后留取标本(以下称方法二),比较3组血标本凝血功能各项指标值的差异。结果方法一与对照组比较,凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)3项指标的差异均具有统计学意义(P<0.01),方法二与对照组比较,PT、INR两项指标差异无统计学意义(P>0.05),而APTT差异有统计学意义(P<0.05)。结论对维持性血液透析以颈内半永久中心静脉导管作为血管通路,使用华法林抗凝的患者进行出凝血检验时,应尽量由外周静脉抽取血标本,当由外周静脉抽血存在实际困难时,可以用方法二由颈内半永久导管留取血标本来代替外周静脉抽血,但必须在送检标本上注明抽血方式以便临床医生参考。

Objective To investigate the feasibility of using blood samples from internal jugular vein by vein catheter instead of peripheral vein on maintained hemodialysis patients with permanent central vein catheter when monitoring the coagulation time on hemodialysis patients taking warfarin. Methods Thirty maintained hemodialysis patients with permanent central vein catheter taking warfarin recruited in this study. Get the blood samples from the same patient at the same time by three different methods：routine blood specimens from peripheral vein as a control;20 ml blood specimens from permanent catheter in jugular vein（ method one,group one）;40 ml blood specimens from permanent catheter in jugular vein（ method two,group two）. Compares the coagulation time among those groups. Results Compared to the control group,the prothrombin time（ PT） and international normalized ratio（ INR）,activated partial thromboplastin time（APTT）,were of significant difference in group one patient（P〈0. 01）. The levels of PT and INR were the same in control group and group two（ P〈0. 05）,however,APTT level was different in those two group（ P〈0. 05）. Conclusion Blood specimens from peripheral vein is preferred when monitoring the coagulation time on hemodialysis patients taking warfarin. Methods two can be used as a substitute on patients with difficulties of blood drawing under the guidance and interpretation of doctors.