连续性血液净化治疗弥散性血管内凝血时不同抗凝技术效果比较.docVIP

连续性血液净化治疗弥散性血管内凝血时不同抗凝技术效果比较 　 作者：王锦权 刘宝 陶晓根 杨田军 赵劲松 张琳琳 秦玉荣 刘海华 【摘要】 目的： 研究弥散性血管内凝血(DIC)患者行连续性血液净化(CBP)治疗时不同抗凝方法的抗凝效果，并对影响患者预后的因素进行分析。方法： 对ICU收治出现DIC并予CBP治疗的患者56例进行前瞻性观察研究，共行CBP治疗162例次;根据患者28 d病死率分为存活组21例，死亡组35例;根据CBP治疗时所选择的抗凝技术不同，分为小剂量肝素抗凝组、无抗凝剂组、肝素体外抗凝组和枸橼酸钠体外抗凝组;对影响患者预后的因素和不同抗凝技术的效果进行分析。结果： 与存活组比较：CBP治疗前，死亡组APACHEⅡ评分较高(Plt;0.01)、肝胆管损伤较重(Plt;0.01)，血小板计数(BPC)较低(Plt;0.05)。不同抗凝方式组间比较，CBP治疗后次日晨，小剂量肝素组患者的BPC较治疗前升高(Plt;0.01)，D二聚体(DDi)小剂量肝素组较无抗凝剂组及肝素体外抗凝组降低(均Plt;0.01);小剂量肝素组单次CBP治疗时间最长，且CBP并发症发生最少。结论： DIC患者在有效抗凝技术和严密监测凝血指标的前提下，可以耐受CBP治疗;在抗凝方式选择上，小剂量肝素抗凝效果较佳。 【关键词】 弥散性血管内凝血; 连续性血液净化; 抗凝技术 　　[Abstract] Objective: To study the effect of different anticoagulative measures during continue blood purification(CBP) on the patients with disseminated intravascular coagulation(DIC) and analyze influencing factors on prognosis. Methods： Of prospective observational study, 56 cases with DIC were treated with CBP(162 times). The death group and survival group were differentiated by 28day mortality. According to anticoagulation, the patients were grouped as the lowdose unfractionated heprin(LDUFH), nonanticoagulation, regional heparinprotamine anticoagulation(RHPA) and regional citrate anticoagulation(RCA). The curative effect of different anticoagulation and impact factors on prognosis was observed. Results： Compared with the patients in survival group, APACHEⅡ score was higher(Plt;0.01), hepatocholangeitis was more severity(Plt;0.01), blood platelet count(BPC) was lower(Plt;0.01) in death group. Furthermore, BPC was higher after CBP than that of preCBP in LDUFH group(Plt;0.01). Ddimer was lower in LDUFH than that of nonanticoagulation group and RHPA group(Plt;0.01). The duration of CBP was longer and complication was less in LDUFH. Conclusion： The patients with DIC were eligible to CBP on the premise of effective anticoagulation and rigorous monitoring. The anticoagulation of lowdose unfractionated heprin was of the first choice. 　　[Key words] disseminated int