摘要
目的:在前期研究应用HCHD对高危出血患者行HD基础上,深入探讨不同肝素溶媒对此方法安全性和临床应用效果的影响。材料与方法:急、慢性血透高危出血患者14例。自身交叉对照设计,分别以NS和5%GS为肝素溶媒,患者分别先后经历两次不同方式HCHD治疗。观察指标分三组进行自身和组间对照;还观察了不同溶媒对肝素吸附量和吸附稳定性的影响。结果:1.HCHD期间,14例患者未有加重出血的情况,3例活动性出血患者出血停止。2.肝素平均吸附量:GS组4513±1446U,NS组4011±444U;仅在NS冲洗液中检测到少量肝素的释放。3.血APTT水平,HCHD期间基本无变化,而同期HD组延长了360%,(P<0.001)。其余指标三组间无显著性差异(P>0.05)。结论:极性溶媒NS对HCHD肝素吸附量、体内凝血系统无明显影响,对于高危出血、尤其是活动性出血患者,HCHD是一种简便、安全、有效的无肝素透析方法。
Objective:The aim of this study was to demonstrate further the impact of different heparin menstruums(NS or 5%GS) on heparin content bound by Hemophan, and to evaluate and optimize the safety and clinical outcome of HCHD. Methods: 14 acute and chronic dialysis patients with high risk for bleeding were enrolled in the cross-over HCHD study. Each patients underwent HCHD in two different stages. All parameters were compared between NS group and GS group. Meanwhile, NS and 5% GS were detected for their effect on heparin adsorption and the adsorption stability upon dialyzer. The same patients on routine hemodialysis (HD) served as control group. Results: 1. During HCHD treatment, no sign of inducing or exacerbating bleeding tendenty was observed among the 14 patients at high risk for bleeding, and the existing bleeding was stopped in 3 of the patients with active hemorrhage. 2. Priming of heparin upon membrane by 5%GS showed 11.1% more adsorption of hepatin (4513±446U) than by NS (4011±444U). Heparin release could be detected only in the flush of NS (4.3%). This suggested that 5% GS provided higher and more stable adsorption of heparin than NS. 3. Level of plasma APTT remained unchanged during HCHD compared with predialysis level. In contrast, plasma APTT level was enhanced 360% (P<0.001). After the first use of dialyzer, value of the clearance for solutes, KT/V, fiber bundle volume, degree of clotting in dialyzers and extracorporeal circuits showed no significant difference among the three groups (P>0.05). Conclusion: These results indicated NS, a polar solution, provided stable adsorption of heparin and effective anti-coagulation in dialyzer and extracorporeal circuits and no activation of coagulation pathways happen in patients during HCHD. Therefore, HCHD is a simple, safe and efficient approach to managing the patients at high risk for bleeding, especially patients with active bleeding.
出处
《感染．炎症．修复》
2000年第1期42-46,共5页
Infection Inflammation Repair
关键词
血液透析
溶媒
肝素
肝素吸附
Hemodialysis Menstruum Heparin Heparin-coated
