摘要
目的 :探讨肝素抗凝治疗肺血栓栓塞 (PTE)症时 ,尽快达到部分凝血活酶时间 (APTT)值在4 5～ 90s区间 (简称达标 )的个体维持剂量及影响因素。方法 :分析 4 2例接受肝素持续静脉点滴法抗凝治疗的PTE病人的临床资料 ;观察 72h内个体肝素用量及达标状况 ;比较达标组与未达标组 ,超标组肝素用量的差异及出血发生率 ;分析其影响因素。结果 :4 2例PTE患者中达标 31例 ,占 73 8%。达标者每人每日肝素平均剂量为 2 182 1u ,所用肝素维持量中位数为 12 9u·kg- 1 ·h- 1 。超标组出血副作用的发生率高于达标组 ,2组有显著性差异 (P <0 0 5 )。治疗反应值 (溶栓或负荷量肝素治疗后即刻APTT值与基础APTT的比值 )与肝素用量呈反比关系。结论 :肝素维持量个体差异大。达标组所需肝素量中位数低于国外推荐剂量 (18u·kg- 1 ·h- 1 )。发病危险因素及病程为其主要影响因素。无家族遗传倾向及恶性肿瘤疾病的急性肺栓塞患者若治疗反应值 >1 5 ,推荐首选肝素维持剂量为 13u·kg- 1 ·h- 1 。
Objective:To determine individual maintenance dosage of heparin and its influencing factors on anticoagulation therapy in pulmonary thromboembolism when activated partial thromboplastin time (APTT) achieve therapeutic range: 45～90 seconds.Method:From the data of forty two patients who received continuous intravenous infusion of heparin, the total dosage and average dosage of heparin in the first 72 hours were calculated. The heparin dosage and the incidence of side effect between patients whose APTT ratios achieve 1.5 to 2 5 and whose not were compared; The possible reasons for influencing heparin requirement were determined.Result:Thirty one of forty two patients with pulmonary thromboembolism achieved APTT therapeutic range, occupying 73 8% of all. The average dosage of heparin of each individual per day was 21821 units. The median of maintenance dosage when APTT ratios achieved the target was 12 9 units/kg/h. Patients whose APTT ratios did not achieve the target had bleeding incident higher than whose APTT did ( P <0 05). There is a inverse relationship between APTT ratio (defined as measured APTT divided by patient baseline APTT) and heparin requirement.Conclusion:There is obvious individual difference of heparin maintenance dosage to achieve therapeutic range. The risk factors and course of disease are major influencing factors .The median of heparin dosage when APTT ratios achieved the target was less than 18 units/kg/h, which was recommended abroad. To achieve APTT ratios higher than 1 5 promptly, we recommend to set heparin maintenance dosage in 13 units/kg/h for patients with acute pulmonary embolism, but without hereditary tendency and tumor history. [
出处
《心肺血管病杂志》
CAS
2003年第2期76-78,82,共4页
Journal of Cardiovascular and Pulmonary Diseases
