摘要
目的 :在前期研究应用血仿膜吸附法无肝素透析 (HCHD)对高危出血患者行血液透析 (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。方法 :急、慢性 HD高危出血患者 14例。自身交叉对照设计 ,分别以生理盐水 (NS)和 5 %葡萄糖 (GS)为肝素溶媒 ,每一患者分别先后经历两次不同方式HCHD治疗。观察指标分 3组进行自身和组间对照 ,同时观察不同溶媒对肝素吸附量和吸附稳定性的影响。结果 :1HCHD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(4 5 13± 144 6 ) U ,NS组 (4 0 11± 44 4) U;仅在 NS冲洗液中检测到少量肝素的释放。 3血活化部分凝血活酶时间 (APTT)水平 :HCHD期间基本无变化 ,而同期 HD组延长了 2 74% (P<0 .0 1)。其余指标 3组间无显著性差异 (P>0 .0 5 )。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:To further demonstrate the impact of different heparin menstruums〔normal saline(NS) or 5% glucose(GS)〕on heparin content bound by Hemophan,and to evaluate and optimize the safety and clinical outcome of hemodialysis using heparin coated hemophone(HCHD).Methods:Fourteen acute and chronic dialysis patients at high risk for bleeding,were enrolled in the crossover HCHD study.Each patient underwent HCHD in two different stages.All parameters were compared between NS group and GS group.Meanwhile, the effect of NS and 5% GS on heparin adsorption and the adsorption stability upon dialyzer was evaluated. The same patients on routine hemodialysis(HD) served as control group. Results:①During HCHD treatment,no sign of inducing or exacerbating bleeding 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.②Priming of heparin upon membrane by 5%GS showed 12 5% more adsorption of heprin〔(4 513±1 446)U〕 than by NS〔( 4 011 ± 444)U〕. Heparin release could be detected only in the flush of NS(4 4%).This suggested that 5%GS provided higher and more stable adsorption of hepatin than NS.③Level of plasma activated partial thromboplastin time(APTT) remained unchanged during HCHD compared with predialysis level.On the contrary,plasma APTT level enhanced 274%( P <0 01) in HD group.After the first session of dialysis,the 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 (all P >0 05).Conclusions:These results indicate NS,a polar solution,provided stable adsorption of heparin and effective anticoagulation in dialyzer and extracorporeal circuits,and no activation of coagulation pathways occurred 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
《中国危重病急救医学》
CAS
CSCD
2001年第1期15-19,共5页
Chinese Critical Care Medicine
基金
军队"九五"医药卫生科研基金资助项目! (No.96 M15 1)
解放军军医进修学院硕士研究生论文获奖项目!军队科技进步二等奖 (No.972 15 5
