摘要
目的观察血液净化中肝素诱导的血小板减少症(HIT)发生及治疗情况,以为其临床治疗提供指导。方法选择行血液灌流(HP)患者341例,连续性静脉-静脉血液滤过(CVVH)患者32例,复合人工肾(CV-VH+HP)患者5例,均给予普通肝素抗凝,观察HIT发生率、发生时间,检测治疗前后血小板的数量、凝血功能,观察出血情况、恢复时间和治疗效果。结果 HP患者中7例在治疗4～36 h后发生HIT(发生率2.05%),血小板最低22×109/L,停用肝素48～96 h血小板恢复正常。CVVH患者中2例发生HIT(发生率6.25%),其中1例在治疗第24 h发生HIT,血小板最低为15×109/L,停用肝素48 h血小板恢复正常;1例在治疗第28 h出现出血症状,血小板进行性下降,最低8×109/L,立即停用肝素,输入新鲜冰冻血浆、浓缩血小板后出血停止,72 h后血小板升至正常。CVVH+HP患者未发生HIT。结论血液净化应用肝素抗凝时应密切观察病情变化,动态监测血小板,对HIT患者立即停用肝素、及时处理。对肝素"过敏"的高危患者应采用无肝素血液净化。
Objective To observe incidence rate,occulwenee time,recovery time and effects of treatment of heparin in- duced thrombocytopenia （HIT） during blood purification. Methods Select 341 cases of patients with hemoperfusion（HP） hospitalized in the First Affiliated Hospital of University of South China,32 cases of patients with composite artificial kidney （ CVVH ＋ HP） during Jan. 2009 to Jan. 2012,and give them with continuous veno-venous hemofihration（CVVH） and 5 cases of patients with heparin for anticoagulant. Then test the number of platelet before and after the treatment ,the coagulation func- tion, and observe bleeding and effects of treatment. Results There was 7 cases during the 4th - 36th hour of HP（ HIT inci- dence rate of 2.05% ）, the lowest platelet was 22 ×10^9/L, resumed 48h - 96h hours after stopping heparin. Two cases of thrombocytopenia occurred in patients with CVVH（ HIT incidence rate of 6.25%）. One appeared HIT at the 24th hour,plate- let turned to the lowest of 15 ×10^9/L,and recovered to normal 48 hours later after stopping heparin. The other case bled at the 28th hour, platelet continued reducing to the lowest of 8×10^9/L, heparin was immediately stopped, fresh frozen plasma and condensed platelets was infused, then bleeding ceased and platelets increased to normal 72 hours later. There was no case of thrombocytopenia occurred in patients with CVHH ＋ HP. Conclusions It is essential to observe the changes of disease condition closely, and test platelet dynamically. For patients with HIT, the using of heparin must be stopped and prompt treatment must be taken iunnediately and patients who are sensitive to heparin should receive blood purification without heparin.
出处
《中南医学科学杂志》
CAS
2013年第1期54-57,共4页
Medical Science Journal of Central South China
关键词
肝素
血液灌流
连续性血液净化
血小板减少症
heparin
hemoperfusion
continuous blood purification
thrombocytopenia
