血液透析患者肝素和低分子量肝素的合理剂量  

Appropriate dosage of unfraction heparin and low molecular weight heparin in hemodialysis patients

作　　者：肖青[1] 孙雪峰[1] 张冬[1] 马志芳[1] 吴明歌[1] 王慧[1] 陈香美[1] 

机构地区：[1]解放军总医院肾内科全军肾脏病研究所暨重点实验室,北京100853

出　　处：《中华医学杂志》2010年第3期187-191,共5页National Medical Journal of China

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

摘　　要：目的探讨血液透析（HD）患者应用普通肝素（UFH）和低分子量肝索（LMWH）的合理剂量。方法选取38例HD患者，随机分为4个治疗组，给予6种抗凝方法。小剂量UFH组（10例）：UFH首剂35U／kg，追加10U·kg^-1·h^-1；小剂量UFH＋预冲组：病例和UFH剂量同小剂量UFH组，并HD前给予40mg/L肝素生理盐水预冲；大剂量UFH组（10例）：UFH首剂55U／kg，追加16U·kg^-1·h^-1小剂量LMWH组（10例）：透析前30min法安明60U／kg（3500U）静脉注射；小剂量LMWH＋预冲组：病例和LMWH剂量同小剂量LMWH组，并Hd前给40mg／L肝素生理盐水预冲；大剂量LMWH组（8例）：透析前30Min法安明80U／kg（5000U）静脉注射。分别在透析前管路动脉端、透析2h管路动脉端和静脉端、透析结束管路动脉端采血，利用Sconoclot血凝分析仪测试玻璃珠活化凝血时间（gbACT）值、凝结速率（CR）值和血小板功能（PF）值。结果（1）小剂量UFH组和小剂量UFH＋预冲组：与HD前比较，HD2b的动脉端和静脉端的gbACT值均明显延长、CR值明显减少，HD结束后gbACT值和CR值无明显变化；但2组间各个时点的各种检测指标无明显差别。（2）小剂量LMWH组：各个时点的gbACT值无明显差别；与HD前比较，CR值在HD2h的动脉端和静脉端均明显减少，但HD结束后无明显变化。（3）小剂量LMWH＋预冲组：与HD前比较，gbACT值HD2h动脉端明显延长，但HD2h静脉端和HD结束无明显变化；CR值HD2h的动脉端和静脉端均较小剂链LMWH组进一步减少，但HD结束后恢复至透析前水平：（4）大剂量UFH组和大剂量LMWH组：与HD前比较，在HD2h的动脉端和静脉端以及HD结束，gbACT值均明显延长，CR值明显减少。结论小剂量UFH抗凝效果充分、日．不增加出血风险；小剂量LMWH可达到一定的抗凝效果；大剂量UFH和LMWH可引起出血风险；40mg／L肝素生理盐水预冲增加小剂量LMWH抗凝效果，但也�Objective To investigate the appropriate dose of unfraction heparin and low molecular weight heparin （LMWtt） in hemodialvsis patients. Methods Thirty-eight hemodialysis patients were enrolled and randomly allocated into four groups. The initial bolus dose for the Low-dose （LH, n = 10） and high-dose heparin （HH, n = 10） groups were 35 U/kg and 55 U/kg, respectively. The repeated maintenance dose for both groups were 10 U/kg· h and 16 U/kg ·h, respectively. Fragmin were administered as single bolus （60 U/kg or 80 U/kg） at 30 minutes before hemodialysis in Low-dose LMWH （LLMWH, n = 10） and High-dose LMWH （HI,MW,n = 8） group, respectively. Furthermore, the dialysis circuits in I,UFH and LLMWUFH groups were primed with with 4 mg/dl heparinized saline before hemodialysis. Glass bead active clotting time （ gbACT）, clot rate （CR） and platelet function （PF） were examined using Sonoclot aoalysator at 0 h ,2 h and the end of hemodialysis at the arterial circuit and 2 h at the venous circuit. Results （ 1 ） LH and LUFH： the increase of gbACT and decrease of CR at the arterial circuit and the venous circuit at 2 h of hemodialysis were siguifieant compared with baseline. While they recovered at the end of hemodialvsis. No difference between the two groups at different time points was found, either. （2）LLMWH：No change were found in gbACT during hemodialysis. CR at the arterial circuit and the venous circuit were significantly decreased at 2 h and recovered at the end of hemodialysis. （3） LLMWUFH：gbACT at the arterial circuit was significantly increased only at 2 h of hemodialysis. CR at the arterial circuit and the venous circuit at 2 h of hemodialysis were significantly decreased and recovered when hemodialysis finished. （4） HH and HLMWH： gbACT were significantly increased and CR were rapidly decreased at both the arterial circuit and venous circuit at 2 h of hemodialysis. Conclusion Low-dose heparin was effective and safe as anticoagulant in hemodialysis. Low-dose l

关 键 词：肾透析 肝素 肝素 低分子量 

分 类 号：R692.5[医药卫生—泌尿科学] R459.5[医药卫生—外科学]