在肝素抗凝的连续肾脏替代治疗中活化部分凝血活酶时间适宜时间的研究  

Suitable Time of APTT in Continuous Renal Replacement by Heparin Anticoagulation

作　　者：马驰骋[1] 芦昌慧[1] 刘爱军[1] 路平[1] 牟伟[1] 张慧明[1] 刘平丽[1] 陈博[1] 

机构地区：[1]山东省济南市第四人民医院ICU,250031

出　　处：《中国全科医学》2010年第18期1992-1993,1996,共3页Chinese General Practice

摘　　要：目的研究在连续肾脏替代治疗中采用肝素抗凝过程中活化部分凝血活酶时间(APTT)的适宜时间范围。方法对比分析使用连续静脉-静脉血液滤过(CVVH)和连续静脉-静脉血液透析滤过(CVVHDF)的88例危重患者的320次过滤时间段中滤器寿命和出血并发症的发生率。结果在所有用肝素治疗的患者中滤器凝血的总发生率为30.5/1 000 h,在APTT为35～44 s时,滤器凝血发生率为90.9/1 000 h;APTT为45～54 s时,滤器凝血发生率为38.2/1 000 h;APTT为55～69 s时,滤器凝血发生率为25.1/1 000 h;APTT≥70 s时,滤器凝血发生率为18.8/1000 h,不同APTT时滤器凝血发生率间差异有统计学意义(P<0.01)。出血的总发生率为6.2/1 000 h。APTT为35～44 s时,出血发生率为3.0/1 000 h,APTT45～54 s和APTT延长到55～69 s时的出血发生率分别为4.9/1 000 h和5.1/1 000 h,≥70 s时出血发生率明显增加,为9.8/1 000 h,不同APTT时患者出血发生率间差异有统计学意义(P<0.05),出血发生率随APTT的延长而逐渐增高。采用CVVH治疗者和采用CVVHDF治疗者比较,滤器寿命及患者出血发生率间差别均无统计学意义(P>0.05)。结论在APTT为55～69 s时,肝素治疗的安全性和有效性最佳。Objective To research the suitable time of activated partial thromboplastin time（APTT） in continuous renal replacement therapy by heparin anticoagulation.Methods The service life of filter and bleeding complications incidence were determined in 88 patients receiving continuous venovenous hemofiltration（CVVH） and continuous veno-venous hemodiafiltration（CVVHD） during the period of 320 filtrations.Results In all patients treated with heparin,the overall incidence of filter coagulation was 30.5 /1 000 h,the filter coagulation rates were 90.9 / 1 000 h,38.2/1 000 h,25.1/1 000 h,18.8/1 000 h,respectively when APTTs were 35～44 s,45～54 s,55～69 s,≥70 s,respectively.The difference was significant（P0.01）.The overall incidence of bleeding was 6.2/1 000 h.The incidences of bleeding were 3.0/1 000 h,4.9/1 000 h,5.1/1 000 h,9.8/1 000 h,respectively when APTTs were 35～44 s,45～54 s,55～69 s,≥70 s,respectively,the difference was significant（P0.05）.The bleeding incidence increased gradually with APTT prolongation.There was not significant difference in filter service life,bleeding incidence between patients receiving CVVH and CVVHDF（P0.05）.Conclusion The safety and effectiveness are the best when APTT is 55～69 s.

关 键 词：连续肾脏替代治疗 抗凝 肝素 活化部分凝血活酶时间 

分 类 号：R459.5[医药卫生—治疗学]