摘要
目的 :探讨不同抗凝方法对伴有低血小板症的多脏器功能障碍综合征 ( Multiple OrganDysfunction Syndrom e,MO DS)患者进行连续性血液净化时的抗凝效果。方法 :将 12例伴有低血小板症的 MO DS患者进行的 54人次的连续性静静脉血液滤过 ( CVV H)分为四组 :小剂量肝素组( LDH)、低分子量肝素组 ( L MW H)、无肝素 ( N H)和小剂量低分子量肝素加盐水冲洗组 ( COM) ,观察各组 12 h内的抗凝效果、出血情况和血小板的变化。结果 :N H组体外循环凝血发生率较其它组高 ( P<0 .0 5)。L DH组和 L MWH组早期出血明显 ,N H组后期出血明显 ,COM组治疗前后则无明显变化 ,但与其它三组比较 ,CO M组的出血次数明显减少 ( p<0 .0 5)。 CVV H过程中 ,各组的凝血酶原活动度 ( PTA )明显回升 ( p <0 .0 5) ,除 LDH组外 ,其它三组的血浆部份凝血活酶时间( APTT )、凝血酶原时间 ( PT )及凝血酶时间 ( TT)逐渐降至正常。 NH组血小板数下降显著 ( p<0 .0 5) ,而肌酐清除不明显。结论 :伴有低血小板症的 MODS患者进行连续性血液净化时 ,小剂量低分子量肝素加盐水冲洗的抗凝效果较好、不增加出血危险。
Objective To investigate the effect of different anticoagulant methods in continuous venous-venous hemofiltration(CVVH) in critical patients with multiple organ dysfunction syndrome(MODS) and thrombocytopenia.Methods:54 Person-times CVVH in 12 patients with MODS and thrombocytopenia were divided into four groups:low dose heparin group(LDH).low molecular weight heparin group (LMWH),no heparin group(NH),minor dose low molecular weight heparin and normal saline washing group(COM).Anticoagulant effect,bleeding and platelet were detected in each group within the first 12 hours CVVH.Results:Blood coagulation in the extracorporeal circuit was more serious in NH than other group.Bleeding was more obvious in LDH and LMWH in early time,,while in NH bleeding was more obvious in late time,no change in COM,but bleeding were less in COM patients.After CVVH,Prothrombin activity(Pa) was improved more in each group,active partial thromboplastin time(APTT),prothrombin time(PT) and thromboplastin time(TT) were normalized gradually in each group except LDH.Comparing to the other three groups,Platelets in NH were reduced more,and the creatinine decreased smaller after 12h CVVH.Conclusions:Anticoagulation with minor dose low molecular weight heparin and normal saline washing for the CVVH to the sever patients with MODS and thrombocytopenia was more effective,less bleeding and less impact on platelet.
出处
《透析与人工器官》
2004年第3期12-16,共5页
Chinese Journal of Dialysis and Artificial Organs
