新生儿体外膜肺氧合患者肝素抗凝抗Xa因子活性及活化部分凝血活酶时间监测评价

Evaluation of Anti-Xa factor activity and activated partial thromboplastin time in extracorporeal membrane oxygenation neonatal patients with heparin anticoagulant

目的探讨抗Xa因子活性和活化部分凝血活酶时间(APTT)在新生儿体外膜肺氧合(ECMO)支持治疗中的监测价值,分析抗Xa因子活性与APTT的相关性,分析抗凝血酶(AT)、总胆红素和血红蛋白对抗Xa因子活性的影响。方法回顾性分析2018年1月至2021年1月就诊于广州市妇女儿童医疗中心的17例ECMO支持治疗患者,收集患者临床资料,采集患者静脉血并检测抗Xa因子活性、APTT、AT、血红蛋白和总胆红素水平。分析抗Xa因子活性与APTT的相关性,并分析血红蛋白、总胆红素及AT对抗Xa因子活性的影响。结果新生儿ECMO支持治疗期间,抗Xa因子活性与APTT比较,抗Xa因子活性相对于APTT在治疗范围内的比例较低。相关性分析结果显示,抗Xa因子活性与APTT呈明显正相关,AT水平与APTT呈弱相关,AT水平与抗Xa因子活性相关性不显著,所有抗Xa因子活性与APTT均未能同时达到治疗范围。结论单项指标不能准确对新生儿ECMO支持治疗使用肝素进行监测,确定最佳的监测方案需要更多的凝血指标支持。

Objective To investigate the monitoring value of Anti-Xa factor activity and activated partial thromboplastin time(APTT)in neonatal undergoing extracorporeal membrane oxygenation(ECMO)supportive therapy.The correlation between Anti-Xa factor activity and APTT is analyzed,and the effect of antithrombin(AT),total bilirubin and hemoglobin on the Anti-Xa factor activity is analyzed.Methods A retrospective analysis was made of 17 ECMO supportive patients who were treated in Guangzhou Women and Children′s Medical Center from January 2018 to January 2021,and the clinical data of the patients were collected.Venous blood was collected from patients to detect Anti-Xa factor activity,APTT,AT,hemoglobin and total bilirubin levels.The correlation between Anti-Xa factor activity and APTT was analyzed,and the effects of hemoglobin,total bilirubin and AT on Anti-Xa factor activity were analyzed.Results During neonatal ECMO supportive therapy,the proportion of Anti-Xa factor activity relative to APTT in the therapeutic range was lower than that of APTT.The results of correlation analysis showed that the Anti-Xa factor activity was significantly positive correlated with APTT,AT level was weakly correlated with APTT,there was no significant correration between AT level and Anti-Xa factor activity.All Anti-Xa factors activity and APTT failed to reach the therapeutic range at the same time.Conclusion A single indicator cannot accurately monitor the use of heparin in neonatal ECMO supportive therapy,and more coagulation indicators support are needed to determine the optimal monitoring program.