不同肝素用法对MHD患者血液灌流抗凝效果比较研究.docVIP

精品论文 参考文献 不同肝素用法对MHD患者血液灌流抗凝效果比较研究 朱赞东 　　（韶关市第一人民医院血透室 512000） 　　【摘要】目的 比较改良的肝素抗凝方案与标准操作规程推荐的方案对为持续血液透析（MHD）患者血液灌流抗凝效果差异。方法　 60例规律进行血液灌流的MHD患者随机分为两组。A组使用的抗凝方案为首剂量0.5mg/kg，追加剂量10mg/h，B组患者的HP抗凝方案是首剂与追加剂量均为平常透析肝素剂量的2倍。观察每位患者连续2次血液透析联合血液灌流治疗中的凝血情况及治疗后的出血情况。结果 　A组患者在治疗中灌流器或透析器凝血的发生率要显著高于B组，A组患者治疗后压迫止血的时间也要显著长于B组。结论 　改良的HP肝素抗凝方案具有很好的临床实用性，值得临床上普遍推广。 　　【关键词】血液灌流 肝素 抗凝 　　【中图分类号】R552 【文献标识码】A 【文章编号】2095-1752（2014）09-0180-02 　　 　　The Comparing Study of the Different Usage of Heparin on the Anticoagulation During the Hemoperfusion in MHD Patients 　　Zhu Zan-dong 　　【Abstract】Objective To compare the effect of modified anticoagulation plan with heparin and the SOP suggested anticoagulation plan on maintenance hemodialysis(MHD) patients during the procedure of hemoperfusion. Methods 60 MHD patients with regular hemoperfusion were randomly divided into two groups. For patients in A goup, a first bolus of heparin 0.5 mg/kg was given at the beginning of the procedure of hemoperfusion, then followed by heparine 10mg/h. For patients in B group, the dose of heparine during the hemoperfusion was double of the dose used in procedure of dialysis. We observed continual 2 times of hemodialysis combined with hemoperfusion of all the patients. The coagulation during the procedure and bleeding after the procedure were recorded. Results For patients in A group, the incidence of coagulation in hemoperfusion apparatus or hemodialyzer were higher than patients in B group, and the oppression hemostasis time was also longer than the patients in B group. Conclusions The modified heparin anticoagulation plan for hemoperfusion has good clinical utility. It is worthy of further widespread application in clinic. 　　【Key words】 Hemoperfusion Heparin Anticoagulation ???　随着血液净化技术的快速发展，血液灌流（hemoperfusion, HP）这种新的血液净化技术在血液净化中心已广泛应用[1]。血液透析联合血液灌流可以达到同时清除大、中、小分子毒素的作用，显著提高维持性血液透析（maintenance hemodialysis,MHD）患者的生活质量。血液灌流技术的理论与操作流程目前均已比较成熟，但由于MHD患者