运用肝素酶血栓弹力图对等管腔容积肝素钠封管后凝血功能的评价  

Affect evaluation to coagulation function in the patients with central venous catheter locked with heparin

作　　者：杨涛[1] 王春丽[1] 刘音[1] 王玉柱[1] 

机构地区：[1]北京市海淀医院肾内科,北京100080

出　　处：《世界临床药物》2015年第10期679-681,701,共4页World Clinical Drug

摘　　要：目的采用血栓弹力图试验检测,分析应用肝素钠注射液经透析用中心静脉导管按管腔标注容积封管的透析患者体内是否存在肝素钠,以及其对患者凝血功能的影响。方法共53例慢性肾脏病5期患者入组,分为临时导管组（n=16）、Permcath导管组（n=14）及Palindrome导管组（n=23）。所有患者在导管置入后缓慢注入与标注的管腔容积等量的肝素钠注射液封管,15~20 min后从外周静脉采血,以血栓弹力图肝素酶对比试验检测凝血功能。结果置管前三组性别、年龄和置管前凝血相关指标组间差异无统计学意义。置管后只有2例患者肝素酶血栓弹力图检测结果为阴性,占全部检测者的3.8%。血栓弹力图反应时间为（26.84±7.94）s,经肝素酶修正后血栓弹力图反应时间为（8.69±2.57）s,两者差值为（17.92±6.35）s;三组血栓弹力图反应时间、经肝素酶修正后血栓弹力图反应时间及差值比较,组间差异均无统计学意义。结论血液透析用中心静脉导管按管腔标注容积肝素钠封管时,可即刻出现肝素钠溢入体内,影响机体凝血功能。Objective To observe the coagulation function of dialysis patients who receive central venous catheter（CVC） locked with heparin, to measure the heparin existed in patient＇s body. Methods A total of 53 patients with chronic kidney disease（CKD） in stage 5 were enrolled, and divided into temporary catheter group（n=16）, ＂Permcath＂ catheter group（n=14） and ＂Palindrome＂ catheter group（n=23）. All the patients received CVC locked with heparin sodium. Then the blood sample drawn from peripheral venous was conducted heparinase-modifi ed thromboelastography test to examine coagulation function and heparin in blood. Results Before cannulation, there were no statistics differences among the three groups in gender, age and coagulation index. After cannulation, only 2 cases（3.8%） were examined negative by heparinasemodifi ed thromboelastography test. The reaction time of thromboelastography（R） was（26.84±7.94）s, and while the data of subtracting RH from R（△R） revised by heparin enzyme（RH） was（8.69±2.57）s, of which the difference was（17.92±6.35）s. Conclusion When CVC for dialysis is locked with heparin, the heparin may leak into the body immediately. It can affect the coagulation function of dialysis patients.

关 键 词：血液透析 中心静脉导管 肝素钠 血栓弹力图 

分 类 号：R692[医药卫生—泌尿科学] R973.2[医药卫生—外科学]