抗Xa因子在日间CRRT低分子肝素抗凝监测中的临床应用  

Anticoagulant monitoring of anti-Xa factor in daily CRRT using low molecular weight heparin

作　　者：张旭[1] 周孟赢 曹盛吉 李龙凯[1] ZHANG Xu;ZHOU Mengying;CAO Shengji;LI Longkai(Department of Nephrology,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China;Department of Laboratory,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)

机构地区：[1]大连医科大学附属第一医院肾内科,辽宁大连116011 [2]大连医科大学附属第一医院检验科,辽宁大连116011

出　　处：《大连医科大学学报》2018年第3期230-233,共4页Journal of Dalian Medical University

基　　金：国家自然科学基金青年科学基金项目(31700847)

摘　　要：目的探讨抗Xa因子在日间连续性肾脏替代治疗(CRRT)低分子肝素抗凝监测中的临床应用。方法选择危重症慢性肾脏病5期进行日间CRRT治疗的患者62例,治疗过程中应用低分子肝素抗凝,分为抗凝未达标组、抗凝达标组和抗凝超标组。测定血红蛋白、血小板、抗凝血酶III、基础血肌酐值、基础APTT值,对治疗1 h抗Xa因子值、治疗1 h以及结束时APTT及肌酐下降率进行监测。结果抗Xa因子三组间比较,差异均有统计学意义,P<0.05。抗凝达标组抗Xa因子为(0.62±0.37)IU/m L。1 h APTT抗凝未达标组与超标组比较,差异有统计学意义,P<0.05;肌酐下降率抗凝未达标组与其他两组比较,差异均有统计学意义,P<0.05。结论抗Xa因子为(0.62±0.37)IU/m L时提示治疗安全、有效;抗Xa因子与APTT相比较,抗Xa因子对临床出血事件、血栓形成提示更有效。Objective To explore the clinical application of anti-Xa factor monitoring anticoagulation of low molecular weight heparin（LMWH） in daily CRRT. Methods Totally 62 critically ill patients were selected,who had stage 5 chronic kidney disease and received daily CRRT with low molecular heparin anticoagulation in the treatment. The patients were divided into 3 groups,including below-standard anticoagulation group,standard anticoagulation group,and above-standard anticoagulation group. Serum levels of hemoglobin,platelet,antithrombin III,basic serum creatinine,and basic APTT were measured. Anti Xa-factor at 1 hour and APTT at 1 hour and the end of treatment creatinine rate descending were using for monitoring anticoagulant. Results Age,hemoglobin,platelet,creatinine and basic APTT values among the 3 groups were similar（P〉0. 05）. Anti-Xa factor was significantly different among 3 groups（P〈0. 05） with anti-Xa factor in standard anticoagulation group（0. 62 ± 0. 37） IU/mL. One hour APTT was significantly different between below-standard and above-standard anticoagulation groups（P〈0. 05）. The creatinine reduction rate in below-standard anticoagulation group was significantly different compared to the other two groups（P〈0. 05）. Conclusion When anti-Xa factor reaches the level of（0. 62 ± 0. 37） IU/mL,it suggests that the treatment is safe and effective. Compared with APTT,anti-Xa factor is more effective for evaluating clinical bleeding events and thrombosis.

关 键 词：低分子肝素 抗XA因子 APTT CRRT 

分 类 号：R446.112[医药卫生—诊断学] R459.5[医药卫生—临床医学]