无肝素血液透析在肾炎合并高度出血风险透析患者中的应用研究

Application of heparin free hemodialysis in patients with nephritis complicated with high risk of bleeding

目的观察无肝素血液透析在肾炎合并高度出血风险透析患者中的应用效果。方法选取2016年7月至2018年10月海南省人民医院收治的肾炎合并高度出血风险患者共56例为研究对象,对其资料进行回顾分析,按照透析方法将其分为对照组与研究组,各28例。对照组患者给予常规血液透析治疗,研究组给予无肝素血液透析治疗,比较两组患者血液透析过程中透析器凝血变化、透析前后血生化指标变化以及并发症发生情况。结果对照组中,28例患者血液透析达88例次,9例次凝血状况,23例次透析出血症状;研究组中,28例患者血液透析共96例次,18例次凝血状况,8例次透析出血症状。研究组与对照组患者的尿素氮分别为(6.10±0.52) mmol/L、(6.07±0.42) mmol/L,血钾含量分别为(4.12±0.05) mmol/L、(4.11±0.07) mmol/L,均较透析前下降,差异具有统计学意义(P <0.05);研究组与对照组患者的血钙分别为(2.17±0.02) mmol/L与(2.18±0.04) mmol/L,二者比较差异无统计学意义(P> 0.05);研究组患者的血液透析并发症发生率为7.14%,低于对照组的25.00%,差异具有统计学意义(P <0.05)。结论无肝素血液透析的治疗效果与常规血液透析效果相似,但凝血率有所升高,做好血液透析的相关干预对降低出血风险有一定价值。

Objective To observe the effect of heparin free hemodialysis in patients with nephritis complicated with high risk of bleeding.Methods A total of 56 nephritis patients with high risk of bleeding admitted to Hainan People’s Hospital during July 2016 to October 2018 were selected as the study objects,their clinical data were analyzed retrospectively and they were divided into control group and study group,each group with 28 cases.Patients in control group were given with routine blood dialysis,the team give heparin freein patients with hemodialysis treatment,compared two groups of patients with hemodialysis dialyser in the process of blood coagulation changes,changes in blood biochemical indexes before and after dialysis or happening of complications.Results There were 28 cases in control group with 88 times of hemodialysis.Among them,coagulation occurred in 9 cases,and 23 cases with hemodialysis bleeding symptoms in 28 patients.In study group,there were 28 cases taken hemodialysis with a total of 88 times of hemodialysis.Among them,18 cases occurred coagulation,and 8 cases with hemodialysis bleeding symptoms in 28 patients.The blood levels of urea nitrogen in patients of study group and control group were( 6.10 ± 0.52) mmol/L and( 6.07 ± 0.42)mmol/L respectively,and the serum potassium contents were( 4.12 ± 0.05) mmol/L and( 4.11 ± 0.07) mmol/L,both of them were lower than those before hemodialysis,and the difference was statistically significant( P < 0.05).The serum calcium levels of patients in study group and control group were( 2.17 ± 0.02) mmol/L and( 2.18 ± 0.04) mmol/L respectively,and the difference was not statistically significant( P > 0.05).The incidence of complications during hemodialysis in study group was 7.14%,lower than that of control group( 25.00%),and the difference was statistically significant( P < 0.05).Conclusion The therapeutic effect of hemodialysis without heparin is similar to that of conventional hemodialysis,but the rate of coagulation is increased.Therefore,the relevant intervention of hemodialysis having certain value in reducing the risk of bleeding.