改良无抗凝HF对MODS凝血功能及细胞因子的影响  

Effects of HF on the Cytokines and Blood Coagulation without Anticoagulation in MODS

作　　者：罗冰[1] 熊明媚[1] 周嘉敏[1] 李仕成[1] 黄东健[1] 

机构地区：[1]广州医学院第三附属医院,广州510150

出　　处：《热带医学杂志》2010年第7期853-855,906,共4页Journal of Tropical Medicine

摘　　要：目的探讨改良后无抗凝血液滤过技术(HF)对多器官功能障碍(MODS)的凝血功能应用的效果,以及对血清细胞因子的影响。方法采用前瞻性临床研究,对MODS伴有凝血功能障碍需行血液滤过的患者30例采用无抗凝血液滤过(30min对血滤管道冲管1次),对照组22例用低分子肝素抗凝血液滤过方法进行治疗,记录血液滤过前后的血肌酐、尿素氮、血气分析、电解质、凝血功能(PT、PT%、PTINR、APTT及Fbg、血小板等)的变化,管路及血滤器的凝血情况和使用时间,比较治疗前后细胞因子INF-α、IL-6、IL-1β的水平的变化。结果 52例患者血液滤过治疗过程中无死亡,经过改良后无抗凝血液滤过的管路寿命与低分子肝素抗凝血液滤过无明显差异。两组血液滤过治疗后的PT、APTT、Fbg均无明显变化(P>0.05)。研究组治疗后PLT计数比对照组低(P<0.05)。两组血肌酐、尿素氮、pH值及氧合指数(OI)均有显著改善(P<0.05)。与对照组比较,研究组的OI改善明显(P<0.05),血清INF-α、IL-1β、IL-6水平显著下降(P<0.05)。结论 MODS伴凝血功能障碍采用改良后无抗凝血液滤过技术能保证管路与滤器的使用寿命,对凝血指标影响较小,还对改善氧合有帮助,这可能与降低血清细胞因子水平有关。Objective To explore the cytokines,blood coagulation and therapeutic efficacy of hemofiltration（HF）without anticoagulation in multiple organ dysfunction syndrome（MODS）.Methods We retrospectively analyzed 52 patients with MODS and blood coagulation undergoing hemofiltration.The patients were randomly divided into two groups：The study group（30 case）without anticoagulation,the contral group（22 case）with anticoagulation.Blood cytokines（INF-α,IL-6,IL-1β）,gas,serum creatinine,blood urea nitragen（BUN）,electrolyte,prothrombin time（PT）,PT INR,Fbg and platelet count（PLT）at predialysis were analyzed.The blood coagulation of tube pathways and blood filters were recorded.Results None of them died of complications of hemofiltration.The circuit life had no difference between two groups.The circuit life had no correlation with PT,APTT,and Fbg levels before the therapy（P〈 0.05）.The levels of PLT significantly decreased after therapy in study group（P〈0.05）.The levels of blood creatinine,BUN,pH value and oxygenation index（OI）significantly improved after both therapies（P0.05）.Compare with the control group,the OI significantly increased after therapy in study group（P〈0.05）,and the levels of INF-α,IL-1β,and IL-6 significantly decreased（P〈0.05）.Conclusion Hemofiltration without anticoagulation achieves an acceptable circuit life.The strategy can be applied as an alternative to treat MODS accompanied with blood coagulation failure.

关 键 词：血液滤过 肝素 细胞因子 多器官功能障碍 

分 类 号：R552[医药卫生—血液循环系统疾病]