七个血液净化中心842例血液透析患者抗凝方法的流行病学调查及分析  

Epidemiology of anticoagulation for hemodialysis patients： survey of 842 cases in seven hemodialysis centers

作　　者：孙雪峰[1] 肖青[1] 王禹[2] 郝丽荣[3] 林洪丽[4] 张智敏[5] 李冀军[6] 陈香美[1] 

机构地区：[1]解放军总医院、全军肾脏病研究所暨重点实验室,北京100853 [2]中国医科大学附属第一医院 [3]哈尔滨医科大学附属第一医院 [4]大连医科大学附属第一医院 [5]解放军总医院第二附属医院 [6]解放军总医院第一附属医院

出　　处：《中华医学杂志》2009年第9期577-581,共5页National Medical Journal of China

基　　金：国家自然科学基金（30871171）;全军医学科研“十一五”专项基金资助课题（082034）

摘　　要：目的调查分析我国维持性血液透析患者的抗凝方法及特点。方法采用问卷调查方法，调查7个血液净化中心维持性血液透析患者的透析情况、抗凝方法及并发症等情况。结果（1）获得调查资料842例，其中血液透析患者808例（95．9％），血液透析滤过患者34例（4．1％）。（2）以肝素作为抗凝剂606例（74．9％），肝素剂量和使用方式各中心间差异具有统计学意义。（3）以低分子肝素作为抗凝剂223例（26．5％），不同血液净化中心选用的品种存在明显差别，而不同品种的低分子肝素用量之间差异具有统计学意义。（4）原发病为糖尿病127例（15．1％），高血压79例（9．4％），其他疾病636例（75．5％）；不同原发病患者间肝素用量无明显差别，但高血压、糖尿病患者的低分子肝素用量明显低于其他疾病患者。（5）出血倾向患者171例（20．3％），血栓患者67例（8．0％），其他患者604例（71．7％）；肝素应用总量，出血倾向患者显著低于其他患者，而血栓患者与其他患者间差异无统计学意义；低分子肝素剂量在出血倾向、血栓和其他患者间差异无统计学意义。（6）172例（20．4％）患者口服抗血小板药物，其中包括14％血栓栓塞患者和12．8％出血倾向患者；服用抗血小板药物患者的肝素和低分子肝素用量显著增多。（7）仅385例（45．7％）进行过凝血指标检查，且检测频率在出血倾向、血栓和其他患者间差异无统计学意义。结论肝素为血液透析的主要抗凝剂；各血液净化中心实施血液透析抗凝治疗为经验性用药，缺乏必要凝血监测，抗凝剂使用缺乏标准和规范。Objective To investigate the anticoagulant methods and characters of hemodialysis patients in hospitals of Grade m Level A. Methods A questionnaire survey was conducted in 7 hemodialysis centers of class 3 first level general hospital in Beijing, Shenyang, Harbin, and Dalian, on the hemodialysis status, primary diseases, anticoagulation methods, and complications. Results 808 of the 842 patients （95.9%） underwent hemodialysis, and 34 patients （4. 1% ） were subjected to hemodialysis filtration. 606 hemodialysis patients （74.9%） used heparin as the anticoagulant, and the doses and using method were different among different centers. 223 patients （26.5%） used low molecular weight heparin （LMWH） with different kinds, doses and using methods. The underlying diseases included diabetes （ 15.1% ）, hypertension （9.4%）, and other diseases （75.5%）. There was no significant difference in the dosage of heparin among different diseases, while the dosage of LMWH was lower for the diabetes and hypertension patients. 171 patients （20. 3% ） had hemorrhagic tendency, and 67 patients （20. 3% ） suffered from thrombus. The dosage of heparin was lower in the patients with hemorrhagic tendency while no difference was found in the dosages of LMWH among the patients with different diseases. Antiplatelet agents were co-administrated in 172 hemodialysis patients （ 20. 4% ）. The percentages of co-administration of antiplatelet for patients with thrombus and hemorrhagic tendency were 14% and 12.8% respectively. The dosages of heparin and LMWH were higher in the patients with co-administration than those without co- administration. Coagulation marker examination was conducted in only 385 patients （45.7%）, and no difference in the frequency of coagulation marker examination was found among the patients with hemorrhagic tendency, thrombus, and other diseases. Conclusion Heparin is the main anticoagulant in hemodialysis. The anticoagulant methodology in hernodialysis is still empirical without clott

关 键 词：血液透析 抗凝方法 流行病学调查 患者 

分 类 号：R686[医药卫生—骨科学]