低分子肝素對血液透析患者出凝血時間的影響

Comparison of low molecular weight heparins and unfiractionated heparin on anticoagulation effect during hemodialysis

目的探討低分子肝素(Low Molecular Weight Heparin,LMWH)對血液透析患者出凝血時間的影響。方法選擇30例慢性腎功能不全維持性血透患者,透析時分別應用LMWH或普通肝素抗凝,於檢測透析前、透析2h及4h測定血漿活化部份凝血活酶時間(APTT)、凝血酶時間(TT);同時觀察透析過程中的各種不良回應,包括皮膚黏膜的出血情況'穿刺點壓迫止血時間、透析器及管路凝血情況等,進行自身交叉對照分析。結果與UFH組比較,LMWH組靜脈穿刺點壓迫止血時間明顯縮短(P<0.05),透析器及路管均無凝血塊,抗凝效果好。LMWH組透析2hAPTT,TT較血透前輕度延長,透析4h時APTT,TT値接近血透前水準。UFH組透析2h,4h較血透前均明顯延長(P<0.05)。結論血液透析中應用LMWH抗凝療效明顯優於UFH,體外循環凝血發生率低,出血危險性低,是血液透析理想的抗凝劑。

Objective To investigate the influence of low molecular weight heparin(LMWH)and unfractionated heparin(UFH)on coagulation time during hemodialysis.Methods Thirty hemodialysis patients were chosen to use Heparin,Fragmin and Clexane as anticoagulant respectively in three consecutive dialysis sessions.Side effect of post-dialysis bleeding and change of APTT,TT were observed.Results No major bleeding was observed in all cases.As compared with UFH group,there was significantly lower incidence of thrombus formation in dialyzer in LMWH group.Moreover,significant longer APTT,TT were observed in UFH group(P<0.05).Conclusions LMWH provides a good alternative in hemodialytic anticoagulation with low bleeding risk.