肝素酶修饰的血栓弹力图用于血液净化时肝素监测的临床研究  

Application of heparinase-modified thromboelastography monitoring heparin during continuous blood purification

作　　者：邓星平[1] 曾庆波[1] 胡炜[1] 林青伟 陈涛 宋景春[1] 钟林翠 张昕 DENG Xing-ping;ZENG Qing-bo;HU Wei;LIN Qing-wei;CHEN Tao;SONG Jing-chun;ZHONG Lin-cui;ZHANG Xin(Intensive Care Unit,the 94th Hospital of Chinese PLA,Nanchang 330002,Jiangxi,China)

机构地区：[1]解放军第九四医院重症医学科,南昌330002

出　　处：《东南国防医药》2018年第5期476-479,共4页Military Medical Journal of Southeast China

基　　金：江西省卫生计生委科技计划(20185556)

摘　　要：目的研究肝素酶修饰的血栓弹力图(hm TEG)用于持续性血液净化(CBP)时肝素监测的临床价值。方法选取2017年9月至2018年5月解放军第九四医院重症医学科进行CBP治疗时应用肝素抗凝的50例患者,依据CBP抗凝时采用部分活化凝血酶原时间(APTT)监测或hm TEG监测,将患者分为APTT组(19例)和TEG组(31例),比较2组患者血液净化前后序贯性器官衰竭评分(SOFA)评分差值、血液净化时间、肝素总剂量与出血并发症(包括置管处、口腔、鼻腔、胃肠道等部位)情况。结果与APTT组肝素总剂量[45(20~62.5) mg]相比,TEG组的肝素总剂量[73.5(29~84.5) mg]明显增加(P<0. 05);与APTT组的血液净化时间[23(14~29.5) h]相比,TEG组的血液净化时间[26.8(20. 00~47.25) h]明显延长(P<0. 05);与APTT组的SOFA评分减少差值(1.16±1.15)相比,TEG组的SOFA评分差值(2.16±0. 95)明显增加(P<0. 05); 2组间出血并发症比较差异无统计学意义(P>0. 05)。结论应用hm TEG监测CBP时的肝素剂量可以延长滤器使用时间,疗效优于使用APTT监测。Objective To investigate the clinical values of heparinase-modified thromboelastography（hmTEG） monitoring heparin during continuous blood purification. Methods The 50 cases of CBP were selected in the intensive care unit of the 94th People＇s Liberation Army Hospital from Sep 2017 to May 2018.The patients were divided into TEG group （31 cases） and APTT group （19 cases） according to different means of monitoring during continuous blood purification. Complication of bleeding, CBP time, heparin total dose and ΔSOFA score of the patients were compared. Rusults Compared with the heparin total dose[73.5（29-84.5）mg] and CBP time [26.8 （20.00-47.25）h] of TEG group, the heparin total dose [45（20-62.5）mg] and CBP time[23（14-29.5）h] of APTT group were significantly lower （ P 〈0.05）. Compared with the ΔSOFA（2.16±0.95） of TEG group, the ΔSOFA（1.16±1.15） of APTT group were significantly lower （ P 〈0.05）. Conclusion Using hmTEG to monitor heparin during CBP is superior to APTT.

关 键 词：血液净化 肝素酶修饰的血栓弹力图 肝素 凝血 

分 类 号：R446.11[医药卫生—诊断学]