人工肝治疗重型肝炎时抗凝剂对凝血影响的研究

Effects of different anticoagulants on blood coagulation during treatment of severe hepatitis with artificial liver.

目的 探讨人工肝治疗重型肝炎病人时抗凝剂对凝血的影响。方法 2 0例重型肝炎患者按治疗方法或药物不同分为肝素组和低分子肝素 (LMWH)组。肝素组和LMWH组均给予人工肝治疗 ,但所用抗凝剂剂量不同。分别测定两组治疗前后凝血指标的变化。结果 肝素组和LMWH组对血红蛋白均无明显的影响 (P>0 0 5 )。治疗时肝素组可引起凝血酶原时间、激活的凝血活酶时间升高 ,治疗后可恢复正常 ;LMWH组引起二者降低。肝素组和LMWH组均可引起纤维蛋白原、凝血酶时间增高 ,Ⅷ因子降低。肝素组可引起血压下降并发症 ,而LMWH组则无。结论 LMWH应用于人工肝治疗重型肝炎病人时是安全的 ,且对患者的凝血系统影响较小。

Objective To investigate the influence on patients' coagulation of different anticoagulants during the treatment of severe hepatitis with ALSS (artificial liver support system).Methods According to different means of medication,20 severe hepatitis patients were divided into two groups randomly:heparin group,LMWH (low-molecular-weight heparin) group,and the two groups were provided with ALSS.The coagulation changes were evaluated before and after the treatment in two groups individually.Results There was no significant difference in hemoglobin levels before and after treatment in two groups.Prothrombin time (PT) and activated partial thromboplastin time (APTT) prolonged significantly before treatment,but returned to normal after treatment in heparin group;the two values were significantly lowered after treatment in LMWH group.There were increased fibrinogen level,thrombin time (TT) and decreased factor Ⅷ levels in both heparin and LMWH group.Many complications,such as blood pressure lowering,might occur in heparin group,but not in LMWH group.Conclusion It is effective and safe to use LMWH for severe hepatitis patients when treating with ALSS.