CVVH中不同浓度普通肝素钠全身抗凝对滤器使用寿命的影响  

Influence of concentration of heparin sodium on filter in continuous veno-venous hemofiitration

作　　者：王廷海 付研 陈秀凯[2] 姜雪 

机构地区：[1]北京朝阳急诊抢救中心综合内科ICU,100122 [2]首都医科大学附属北京朝阳医院SICU

出　　处：《中国急救复苏与灾害医学杂志》2015年第5期453-455,459,共4页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的比较两种不同浓度普通肝素钠全身抗凝方式在连续性肾脏替代治疗（CRRT）中的抗凝效果。方法选择需行持续性静一静脉血液滤过（CVVH）治疗且应用普通肝素钠全身抗凝的患者，给予首剂量25～30IU／kg后，按普通肝素钠维持的给药浓度不同分为观察组（0．02％普通肝素钠溶液）和对照组（0．5％普通肝素钠溶液），进行自身交叉对照，两组普通肝素钠维持量5～10IU／（kg·h）持续血液前泵泵入，开始4h每小时检测一次活化部分凝血酶原时间（APTT），然后每4h检测一次，来调节肝素的维持量。监测治疗过程单位时间普通肝素钠用量、凝血功能、跨膜压、滤器使用时间等指标。结果42例行CVVH治疗的患者入选，平均单位时间内观察组和对照组的普通肝素钠使用总剂量差异无统计学意义（t=0．512，P〉0．05），而滤器使用时间（实际治疗时间）分别为（19．2±1．6）h和（15．6±2．1）h，差异有统计学意义（t=2．410，P〈0．05）。结论CVVH治疗中不同浓度普通肝素钠全身抗凝，低浓度普通肝素钠抗凝明显延长滤器的使用寿命。Objective To compare the effects of two different concentration of unfractionated heparin sodium in systemic anticoagulant therapy on continuous renal replacement therapy. Methods 42 patients undergoing continuous veno-venous hemofiltration （CVVH） were given unfractionated heparin sodium solution at different concentration alternatively： 0.02% heparin sodium solution was given in the odd-numbered time （observation group） and 0.5% heparin sodium solution was given in the even-numbered time （control group）. Then a self-crossover control trial was performed. ATTP was detected once every hour in the first 4 hours and then once every 4 hours so as to regulate the dose of heparin sodium to maintain the activated prothrombin time （APTT） level at 50-70 S. The values of APTT, prothrombin time （PT）, and international normalized ratio （INR） before and after treatment, the transmembrane pressure （TMP） level during treatment, and the usage time of filter and treatment time were monitored. Results No significant difference in the total dosage of heparin sodium in unit time was found between the observation group and the control group （t=0.512, P〉 0.05）. 4 and 8 hours after CVVH, the TMP values of the control group were both significantly higher than those of the observation group （both P 〈 0.05）. The general treatment and usage time of filter of the observation time were both significantly longer than those of the control group （both P〈 0.05]. Conclusion Low concentration of heparin can extend the filter＇ s lifetime in CVVH.

关 键 词：持续性静-静脉血液滤过(CVVH) 普通肝素钠 浓度 滤器使用寿命 

分 类 号：R495.5[医药卫生—康复医学]