单剂量低分子量肝素在血液透析抗凝中的应用  

A single dose of a low molecular weight heparin for anticoagulation during hemodialysis

作　　者：朱兰英[1] 吴永贵[1] 毛海萍 安业浩 彭文兴[1] 李欣[1] 曾牡华 陈惠珍[1] 

机构地区：[1]中山医科大学第一附属医院血液净化中心,中山医科大学第一附属医院血液病实验室

出　　处：《中华肾脏病杂志》1996年第1期32-35,共4页Chinese Journal of Nephrology

摘　　要：对３０例血透患者进行随机交叉对照研究，比较血透前单剂量注射低分子量肝素（ＬＭＷＨ，速避凝）和持续输注普通肝素（ＳＨ）的疗效和安全性。结果：两组体外循环凝血发生率低且无明显差别，但ＬＭＷＨ组透析器复用次数明显延长（Ｐ＜０．０５），第四次透析２小时尿素氮、肌酐清除率及透析器血液间隙容量无明显下降；ＳＨ组则明显下降（Ｐ＜０．０５）。两组均无出血征象，但ＬＭＷＨ组穿刺点压迫时间明显缩短（Ｐ＜０．０５）；而两组透析２小时血浆肝素活性抗－低分子量肝素（ＦＸａ）水平无明显差别，透析４小时ＬＭＷＨ组明显高于ＳＨ组（Ｐ＜０．０５）；ＬＭＷＨ组部分凝血活酶活化时间（ＡＰＴＴ），凝血酶时间（ＴＴ）仅透析２小时轻度延长，透析４小时基本恢复到治疗前水平，ＳＨ组均明显延长（Ｐ＜０．００１）。我们认为血透前单剂量ＬＭＷＨ能有效、完全地代替ＳＨ。hemodialysis patients were studied in a radomized crossover fashion to compare the efficacy andsafety of LMWH(Fraxiparine) given as a single predialysis bolus injection with SH administered with a continuousinfusion.our results showed clot formation in the extracorporeal circuit was mininal and comparable in bothgroups.However,a significant(P<0.05) increase was seen in the number of dialyzer rease in the LMWH.Com-pared with the SH,there were not significantly(P> 0.05)decreased in 2h clearance of urea,creatinine with theLMWH after the forth sessions,as well as BCV of dialyzers. No major bleeding was encountered with eithergroup,but there was significantly(P<0.05)shortened in the pressure time at the puncture sites in the LMWH. The plasma heparin activity(anti-FXa levels )were comparable in both groups after 2hrs of sessions,they weresignificantly(P<0.05 )higher after 4hrs in the LMWH than in the SH,APTT and thrombin time were onlymarginally effected by the LMWH at 2hrs.They basically returned to predialysis levels by 4hrs,Whereas theywere markedly prolongated by the SH(P<0.01).In conclusion,a single dose of LMWH was an effective,safe al-ternative to SH.

关 键 词：低分子量肝素 肝素 血液透析 抗凝剂 

分 类 号：R459.5[医药卫生—治疗学]