血液透析中不同时间注射低分子肝素钠的抗凝效果

Anticoagulation effect of low molecular heparin sodium with different administration time in hemodialysis patients

目的探讨不同时间给予低分子肝素钠(LMWH)在血液透析中的效果。方法将30例血液透析患者随机分为A、B、C3组,各10例。分别于透析开始后0 min(A组)、15 min(B组)、30 min(C组)给予低分子肝素钠60 IU/kg注射。记录各组透析管路和透析器的凝血情况以及透析中静脉压和跨膜压,观察各组透析前后活化部分凝血活酶时间(APTT)、凝血酶原时间(PT),比较2组穿刺点压迫时间。结果 C组患者透析管路和透析器中凝血程度低于A组和B组(P<0.05);3组患者透析后4 hAPTT、PT均较透析前延长(P<0.01);但透析后3组患者APTT、PT的比较差异无统计学意义(P>0.05);各组透析中跨膜压、静脉压比较差异无统计学意义(P>0.05),透析后穿刺压迫时间比较差异无统计学意义(P>0.05)。结论透析开始后30 min给予低分子肝素钠60 IU/kg可有效缓解透析器及管路凝血情况,有利于透析的顺利进行。

Objective To investigate the anticoagulation effect of low molecular heparin sodium with different administration time in hemodialysis patients. Methods Totally 30 hemodialysis patients were assigned to the Group A,Group B and Group C,with 10 cases in each group.The patients were treated with low molecular heparin sodium 60 IU/kg at 0 min（ Group A）,15minutes（ Group B） and 30 minutes（ Group C） after onset of hemodialysis. The coagulation situation in hemodialysis pipelines and dialyzer was observed. The activated partial thromboplastin time（ APTT）,prothrombin time（ PT）,transmembrane pressure,venous dialysis pressure and compression time of puncture point were compared between groups. Results Patients in Group C had a less severity of coagulation in hemodialysis pipelines and dialyzer compared with those in Group A and Group B（ P〈0. 05）. The APTT and PT of patients were longer 4 hours after onset of hemodialysis,but with no significant difference among three groups（ P〈0. 05）. There was no significant difference in transmembrane pressure,venous dialysis pressure and compression time of puncture point among three groups（ P〈0. 05）. Conclusion The low molecular heparin sodium60 IU/kg administrated 30 minutes after hemodialysis onset show s a sound c anticoagulation effect in hemodialysis pipelinesand dialyzer.