低分子肝素在肾脏病抗凝治疗中的应用 ppt课件.pptVIP

依诺肝素使用后较肝素血小板反应性低 抗凝10分钟后测定血小板反应性 动脉端为透析开始时测得 静脉端为开始后10min测得数据。 ADP诱发纤维蛋白原连结 PF1+2和TAT基线值均无明显区别 PF1+2在依诺肝素和肝素使用后均明显下降 TAT在透后两种抗凝方式不同，其值也有明显差异 第二幅： 依诺肝素的剂量与PF1+2和TAT值相关 TAT在透后两种抗凝方式不同，其值也有明显差异 在依诺肝素组其值与依诺肝素剂量呈负相关 thrombin activatable fibrinolysis inhibitor 凝血酶激活的纤溶抑制物(TAFI) TAT： 凝血酶抗凝血酶复合物 F1+2：凝血酶原片段1+2 PAP：纤维蛋白溶酶-抗纤维蛋白溶酶复合物 thrombin activatable fibrinolysis inhibitor 凝血酶激活的纤溶抑制物(TAFI) TAT： 凝血酶抗凝血酶复合物 F1+2：凝血酶原片段1+2 PAP：纤维蛋白溶酶-抗纤维蛋白溶酶复合物 依诺肝素或达钠肝素单剂量注射与普通肝素标准用法比较 Comparison of effects of different heparins on thrombin activatable fibrinolysis inhibitor in hemodialyzed patients. Comparison of effects of different heparins on thrombin activatable fibrinolysis inhibitor in hemodialyzed patients. 红笔试验为使用依诺肝素的试验， 其余为达肝素钠、那屈肝素、亭扎肝素 Seventeen trials were included in this systematic review, 11 of which were included in the meta-analysis. It was found that LMWH did not significantly affect the number of bleeding events (relative risk, 0.96; 95% confidence interval [CI], 0.27 to 3.43), bleeding assessed by vascular access compression time (weighted mean difference, 0.87; 95% CI, 2.75 to 1.02), or extracorporeal circuit thrombosis (relative risk, 1.15; 95% CI, 0.70 to 1.91) as compared with UFH. LMWH seem to be as safe as UFH in terms of bleeding complications and as effective as UFH in preventing extracorporeal circuit thrombosis. and 11of these were included in the meta-analysis comparing LMWH with UFH (11,28 –32,35,36,38–40). In this meta-analysis, we found that for bleeding events and clotting within the extracorporeal hemodialysis circuit, LMWH seem to be at least as safe and effective as UFH during chronic hemodialysis. No difference was demonstrated in the number 血透患者单剂量依诺肝素注射， single 60 IU/kg Fig. 1. Anti-Xa activity vs time in 30 haemodialysis patients after a single 60 IU/kg (4000±455 IU) bolus of enoxaparin into the afferent line of the dialyser. 10名长期透析患者，120次透析治疗 依诺肝素使用方式：单剂量50 IU/kg，平均3700 IU，或者单剂量1200 IU 然后持续400 IU/h. 透析膜：高通量聚砜膜APS900 高