肾脏透析对凝血和纤溶功能的影响.docVIP

肾脏透析对凝血和纤溶功能的影响 　　[摘要] 目的 探讨肾脏透析对凝血和纤溶功能的影响。方法 随机选择2014年1月―2015年1月期间该院行维持性血透的62例慢性肾功能衰竭患者作为该研究的主要对象，分别于透析前60 min、透析开始后60 min、透析后60 min以及透析后3天，检测其指标包括：血小板计数、凝血酶原时间、凝血酶时间、纤维蛋白原、活化部分凝血活酶时间、D-二聚体以及组织纤溶酶原激活物。结果 透析开始后，血小板计数显著下降，透析结束后，血小板计数为（120±8），明显低于透析前血小板计数（167±15），差异具有统计学意义（P0.05），凝血酶原时间在透析结束后为（19.2±1.8），相较于透析前凝血酶原时间（14.1±0.8）显著延长，差异具有统计学意义（P0.05），活化部分凝血活酶时间在透析后为（44.7±5.5），相较于透析前活化部分凝血活酶时间（29.5±4.3）明显延长，差异有统计学意义（P0.05），透析后得到恢复，透析后组织纤溶酶原活物为（3.29±0.57），与透析前的（0.82±0.21）相比，明显增加， D-二聚体在透析后为（1.43±0.21），相较于透析前（0.82±0.11）显著增高，差异具有统计学意义（P0.05）。 结论 尿毒症患者伴有显著的凝血、纤溶功能紊乱，而由于肾脏透析的影响，可进一步启动患者内源性凝血途径及继发性纤溶。 　　[关键词] 肾脏透析；凝血；纤溶功能；维持性血透；慢性肾功能衰竭 　　[中图分类号] R [文献标识码] A [文章编号] 1674-0742（2015）11（b）-0033-03 　　[Abstract] Objective To investigate the effect of kidney dialysis on coagulation and fibrinolytic function. Methods 62 cases with chronic renal failure underwent maintenance hemodialysis in our hospital from January 2014 to January 2015 were randomly selected as the subjects. The values of indicators such as platelet count， prothrombin time， thrombin time， fibrinogen， activated partial thromboplastin time（APTT）， D-dimer and tissue plasminogen activator were measured in the patients 60min before the maintenance hemodialysis， 60min after the beginning of maintenance hemodialysis， 60min after the maintenance hemodialysis， and 3 days after the maintenance hemodialysis. Results At the beginning of dialysis， the platelet count decreased significantly， the platelet count at the end of dialysis was much lower than that before dialysis[（120±8） vs （167±15）]， the difference was statistically significant（P0.05）. The prothrombin time after dialysis was significantly prolonged than that before dialysis[（19.2±1.8） vs （14.1±0.8）] with statistically significant difference（P0.05）. The APTT was significantly prolonged after dialysis than that before dialysis[（44.7±5.5） vs （29.5±4.3）] with statistically significant difference（P0.05）. Restoration was obtained after dialysis， the tissue plasminogen ac