无肝素连续性静脉-静脉血液滤过在高危出血患者中的应用  

Clinical application of continuous veno-venous hemofiltration without anticoagulation in patients with high risk of bleeding

作　　者：林雅[1] 吴彼得[2] 周雪丽[2] 陈珊莹[2] 刘勇[1] 

机构地区：[1]福建医科大学附属漳州市医院外科重症监护室,363000 [2]福建医科大学附属漳州市医院肾内科,363000

出　　处：《临床肾脏病杂志》2009年第11期497-499,共3页Journal Of Clinical Nephrology

摘　　要：目的探讨对高危出血倾向患者行无肝素连续性静脉-静脉血液滤过（CVVH）治疗的可能性。方法37例患者共行CVVH治疗75例次，分为观察组和对照组。观察组43例次，有高危出血倾向，采用无肝素抗凝；对照组32例次，采用低分子量肝素钙抗凝。回顾性分析2组相关临床指标。结果2组治疗后血肌酐（SCr）、尿素氮（BUN）均降低，差异有统计学意义（P〈0．05），2组SCr、BUN下降率均无统计学差异（P〉O．05）；观察组治疗前、后凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）差异无统计学意义（P〉0．05），对照组治疗后PT、APTT较治疗前延长，差异有统计学意义（P〈0．05）；观察组有凝血功能障碍的患者管路和滤器使用寿命与对照组无统计学差异（P〉0．05），观察组无凝血功能障碍的患者管路和滤器使用寿命短于对照组，差异有统计学意义（P〈0．01）。结论无肝素抗凝技术用于高危出血倾向患者的CVVH治疗疗效肯定，并无增加出血的风险。Objective To explore the application of continuous veno-venous hemofiltration （CV- VH） without anticoagulation in patients with high risk of bleeding. Methods Totally 75 hemofiltration circuits were performed on 37 patients, including 43 circuits at high risk of bleeding with hemofiltra- tion without anticoagulation as experimental group and 32 with anticoagulation by low-molecular weight heparin as control group. Results There was no significant difference in reduction rates of ser- um creatinine（SCr） and blood urea nitrogen （BUN） between two groups（P〉0. 05）. Prothrombin time （PT） and activated partial prothrombin time （APTT） were not prolonged in experimental group （P〉0. 05）, while they were prolonged in control group （P〈0. 05）. No significant difference in circuit life was observed between the patients with coagulation disorders in experimental group and those in control group （P〉0. 05）, but circuit life was significantly decreased in patients without coagulation disorders of experimental group （P〈0. 01 ）. Conclusion CWH without anticoagulation provides a satisfactory therapeutic effect and reduces bleeding risks.

关 键 词：血液滤过 肝素 出血 凝血酶原时间 部分促凝血酶原时间 

分 类 号：R692.5[医药卫生—泌尿科学] R692.505[医药卫生—外科学]