应用血栓弹力图评价血液透析患者肝素剂量  

Evaluation of optimal dosage of heparin in hemodialysis patients by thromboelastograph

作　　者：杨松涛[1,2] 吴虹[1,2] 高晓云[1,3] 胡军[1,2] 肖跃飞[1,2] 

机构地区：[1]航天中心医院 [2]北京大学航天临床医学院肾内科,北京100049 [3]北京大学航天临床医学院输血科,北京100049

出　　处：《北京大学学报（医学版）》2013年第4期625-629,共5页Journal of Peking University:Health Sciences

摘　　要：目的:用血栓弹力图(thromboelastograph,TEG)评价维持性血液透析(maintenance hemodialysis,MHD)患者凝血功能,依据TEG判断血液透析中肝素剂量是否合理。方法:选择MHD患者30例,根据血液透析过程中肝素应用总量不同,分为低剂量组16例(总量<80 u/kg)和高剂量组14例(总量≥80 u/kg)。检测血液透析前患者血红蛋白(hemoglobin,Hb)、血小板计数(platelet,PLT)及常规凝血功能等。血液透析前及血液透析后在管路动脉端,血液透析2 h时在管路静脉端采血,检测TEG及活化部分凝血活酶时间(activated partial thromboplastin time,APTT)。结果:低剂量组肝素首剂为(26.6±6.2)u/kg,追加剂量为(13.7±5.1)u/(kg.h);高剂量组肝素首剂为(42.3±8.2)u/kg,追加剂量为(18.2±4.3)u/(kg.h)。血液透析前,两组Hb、PLT及常规凝血功能检查无明显差别。低剂量组血液透析2 h时APTT明显延长,血液透析后较血液透析前无差别。血液透析2 h及血液透析后TEG R值延长,血液透析后CI负值增大。高剂量组血液透析2 h及血液透析后APTT均明显延长,血液透析2 h时R值明显延长,血液透析后R值、K值延长,MA值缩小,CI负值明显增大。两组间比较,血液透析2 h时高剂量组APTT较低剂量组明显延长,差异有统计学意义,血液透析后高剂量组较低剂量组仍有延长,但差异无统计学意义。两组间血液透析2 h时的R值及血液透析后R值、K值、MA值、CI值差异均有统计学意义。血液透析后APTT与肝素剂量无相关性,而R值与肝素剂量呈正相关(r=0.403,P=0.041)。两组患者透析中跨膜压、静脉压、滤器凝血等无差异。结论:低剂量肝素即可达到充分抗凝,TEG比常规凝血功能检测更敏感地反映患者凝血功能状况,可以为血液透析患者的抗凝治疗提供指导。Objective：To assess the blood coagulation function and investigate the appropriate dose of unfractionated heparin by thromboelastograph in maintenance hemodialysis（MHD） patients.Methods： Thirty MHD patients were enrolled in this study and divided into two groups.The total dose of unfractionated heparin was below 80 u/kg in the low-dose group（LH,n=16）,while it exceeded 80 u/kg in the high-dose group（HH,n=14）.Blood routine tests and conventional coagulation examinations were measured before hemodialysis.TEG and activated partial thromboplastin time（APTT） were examined at the beginning and the end of hemodialysis at the arterial circuit,and the second hour（h 2） at the venous circuit.Results： The initial bolus dose of unfractionated heparin for LH and HH groups were（26.6±6.2） u/kg vs.（42.3±8.2） u/kg and the repeated maintenance dose for both the groups were（13.7±5.1） u/（kg·h） vs.（18.2±4.3） u/（kg·h）.No significant difference was noticed in results from blood routine tests and conventional coagulation parameters between the two groups.In LH group,the increase of APTT at h 2 of hemodialysis was significant compared with the baseline,while it recovered partly at the end of hemodialysis.R value prolonged at h 2 and the end of hemodialysis.CI value was more negative at the end of hemodialysis.In HH group,APTT obviously prolonged at h 2 and the end of hemodialysis.R value also obviously prolonged at h 2 of hemodialysis.At the end of hemodialysis,R and K values prolonged,MA value reduced,and CI value was more negative.APTT was significantly different between the two groups at h 2 of hemodialysis.At the end of hemodialysis,APTT was still extended in HH group,but there was no significant difference.R value at h 2,and R,K,MA,CI values at the end of hemodialysis were significantly different between the two groups.R values at the end of hemodialysis had a direct correlation with the dose of unfractionated heparin（r=0.403,P=0.041）,but APTT had not.There was no significant

关 键 词：血栓弹力描记术 肾透析 肝素 

分 类 号：R459.52[医药卫生—治疗学]