高浓度肝素盐水封管对急性重度中毒患者血液灌流期间导管堵塞及出血风险的影响  

The effect of high concentration heparin saline sealing on thrombosis and bleeding risk during hemoperfusion in patients with acute severe poisoning

作　　者：杨素云 刘晓彬 YANG Suyun 1,LIU Xiaobin 2(1.Department of Emergency,the Third Hospital of Hebei,Xingtai,Hebei 054000,China;2.Department of Clinical Laboratory,the Third Hospital of Hebei,Xingtai,Hebei 054000,Chin)

机构地区：[1]邢台市第三医院急诊科,河北邢台054000 [2]邢台市第三医院检验科,河北邢台054000

出　　处：《国际检验医学杂志》2018年第15期1824-1826,1831,共4页International Journal of Laboratory Medicine

基　　金：邢台市2015年科技局科技支撑计划项目(2015ZC231)

摘　　要：目的研究高浓度肝素盐水封管对急性重度中毒患者血液灌流期间导管堵塞和出血风险的影响。方法纳入90例急性重度中毒患者作为研究对象,随机抽签分为三组,各30例。A组行常规生理盐水封管,B组行低浓度(625U/mL)肝素盐水封管,C组行高浓度(1250U/mL)肝素盐水封管。比较三组凝血功能、导管堵塞及出血发生情况。结果 A组抢救无效死亡3例,B组死亡1例,C组死亡2例,病死率差异无统计学意义(P>0.05)。三组TT、PT及Fib治疗前、治疗24h及治疗48h时水平比较差异无统计学意义(P>0.05),三组间TT、PT及Fib比较差异无统计学意义(P>0.05)。B、C两组APTT显著高于A组(P<0.05)。A组导管堵塞9例,B组3例,C组2例,三组导管堵塞发生率比计较差异有统计学意义(P<0.05),B、C组导管堵塞严重程度显著轻于A组(P<0.05)。A组出血5例,B组8例,C组7例,三组出血发生率及严重程度无显著差异(P>0.05)。结论高浓度肝素盐水封管用于急重症中毒患者能显著降低导管阻塞发生率,且并不增加出血风险,具有较高临床应用价值。Objective To study the effect of high concentration heparin saline sealing on thrombosis and bleeding risk during hemoperfusion in patients with acute severe poisoning. Methods 90 patients with acute severe poisoning were randomly divided into three groups,30 cases in each group.Group A received routine saline sealing,B group received low concentration （625 U/mL） heparin saline sealing,group C underwent high concentration （1 250 U/mL） heparin saline sealing.The coagulation function,the blockage of the duct and the bleeding were compared between the three groups. Results 3 cases died in group A,1 cases in group B,2 cases in group C,there was no significant difference in mortality（ P 〉0.05）,there were no significant difference between the three groups in TT,PT and Fib before,during and after the treatment of 24 h and 48 h（ P 〉0.05）,there were no significant difference in TT,PT and Fib between the three groups（ P 〉0.05）,the APTT in B and C two groups were significantly higher than that in group A（ P 〈0.05）.There were 9 cases of duct obstruction in group A,3 cases in group B,2 cases in group C,there was significant difference in the incidence of obstruction between the three groups（ P 〈0.05）,the severity of obstruction in B and C group was significantly less than that in group A（ P 〈0.05）.There were 5 cases of bleeding in group A,8 cases in group B,7 cases in group C,there were no significant difference in the incidence and severity of bleeding between the three groups（ P 〉0.05）. Conclusion The high concentration heparin saline sealing can significantly reduce the incidence of thrombosis and catheter obstruction and not increase the risk of bleeding in patients with acute severe poisoning,it has high clinical value.

关 键 词：肝素 封管 急性重度中毒 血液灌流 

分 类 号：R446.1[医药卫生—诊断学]