改良抗凝方案在维持性血液透析患者治疗中的应用价值

Value of Modified Anticoagulation Regimen to Treat Maintenance Hemodialysis Abstract

目的探讨维持性血液透析(MHD)患者采用改良抗凝方案对于患者凝血功能、血小板聚集及炎症状态的影响。方法选取2014年1月至2017年1月我院实施MHD治疗的118例患者,采用随机数字表分为改良组、常规组各59例,两组患者均实施MHD治疗,改良组患者采用低分子肝素作为抗凝剂,应用高通量+低通量血液透析器,并调整相应的血液透析模式、透析次数、超滤量、血流量等;对照组采用普通肝素作为抗凝剂,应用低通量血液透析器,采取常规的血液透析方案。结果透析治疗后,改良组的PT、APTT测定值均高于常规组(P<0.05);改良组的TNF-α、IL-1β、IL-6、CRP测定值均低于常规组(P<0.05);改良组的红细胞黏附率低于常规组(P<0.05);两组患者在持续使用相应的抗凝方案3个月后,改良组的不良反应发生率11.85%与常规组的6.78%,差异无统计学意义(P>0.05)。结论 MHD患者采用改良抗凝方案更加有利于改善患者的高凝状态、减轻透析治疗引起的炎症反应程度、降低血小板黏附率,同时并不会显著的增加患者不良反应。

Objective To explore modified anticoagulation regimen in maintenance hemodialysis(MHD)patients on coagulation function,platelet aggregation and inflammation.Methods From January 2014 to January 2017,118 patients who underwent MHD treatment in our hospital were selected.They were divided into modified group(n=59)and conventional group(n=59)by random number table.All were treated with MHD.Formodified group,low molecular weight heparin was treated as anticoagulant.And high-flux+low-flux hemodialysis device was taken by adjusting corresponding hemodialysis mode,dialysis times,ultrafiltration volume,blood flow.For control group,unfractionated heparin was used as anticoagulantwith low application flux hemodialysis machine and conventional hemodialysis program.Results After dialysis,PT and APTT of modified group were higher than those of conventional group(P<0.05).TNF-α,IL-1β,IL-6,and CRP of modified group were all lower than those of conventional group(P<0.05).Red blood cell adhesion rate of modified group was lower than that of conventional group(P<0.05).After corresponding anticoagulation program for 3 months,adverse reaction rate of modified group was 11.85%and that of conventional group was6.78%without statistically significantdifference(P>0.05).Conclusion For MHD patients,it is more conducive that modified anticoagulant regimen could change hypercoagulable state,reduce inflammation degree caused by dialysis treatment and platelet adhesion rate without significantly adverse reactions.