摘要
目的对连续性静脉-静脉血液滤过治疗过程中无肝素抗凝技术进行综合评价。方法2005年1月至4月对四川大学华西医院的42例危重患者行连续性静脉-静脉血液滤过(CVVH)治疗,其中高危出血患者19例采用无肝素技术抗凝,设为观察组;23例采用低分子肝素抗凝,设为对照组(其中3例因故改用无肝素抗凝)。两组置换液速度均为3000mL/h,持续时间12h/d,碳酸氢盐置换液前稀释方式输入。计算溶质下降率,治疗前后检测电解质、酸碱指标、凝血指标;记录心率、平均动脉压、跨膜压及滤器寿命。结果两组治疗后血尿素氮、肌酐均显著下降,但组间比较溶质下降率差异并无显著性意义(P>0.05),对照组活化部分凝血时间(APTT)显著延长(P<0.05)。观察组跨膜压在7h明显升高,而对照组在9h明显升高;观察组滤器的平均寿命短于对照组(P<0.05)。结论CVVH中应用无肝素抗凝技术同样高效、稳定、安全,对于高危出血患者,是保障CVVH治疗持续进行的重要措施。
Objective To evaluate anticoagnlation without heparin during continuous venovenous hemofihration. Methods From January to April of 2005, forty - two critically ill patients by therapy of continuous venovenous hemofiltration （CVVH） were enrolled in our study. Nineteen patients with high risk of bleeding who had received anticoagnlation without heparin were as observation group, and the rest of the patients who had received anticoagulation with low molecular weight heparin were as control group. In the two groups, the replacement fluid rate was 3 000 mL/h; the therapy time was 12 hours/day; the bicarbonate replacement fluid were infused by the mode of predilution. Results The serum level of urea and creatinine were significantly decreased after treatment in the two groups, but there were no difference in the decrease of solution between the two groups. APTr was significantly extended in control group （P 〈 0.05）. Transmem- brane pressure was significantly increased at seventh hours in observation group and at nineth hours in control group. The mean life of filter in observation group was shorter than that in control group （P 〈 0. 05）. Conclusion Anticoagulation without heparin is high efficient, stable and safe. It is an important measure to ensure CVVH continuously for patients with high risk of bleeding.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2006年第7期995-997,共3页
Chinese Journal of Practical Internal Medicine
关键词
血液滤过
肾替代疗法
无肝素抗凝
Hemofihration
Renal replacement therapy
Anticoagulation without heparin
