人工肝治疗过程中同步检测动脉端管路血与外周静脉血中凝血指标的临床意义  

Relationship of coagulation indexes between arterial end-line blood and peripheral venous blood during artificial liver treatment

作　　者：耿华 钟蕊[1] 徐曼曼[1] 李爽[2] 周莉[1] 陈煜[1] GENG Hua;ZHONG Rui;XU Man-man;LI Shuang;ZHOU Li;CHEN Yu(Fourth Department of Liver Disease,Beijing You'an Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院肝病中心四科,100069 [2]首都医科大学附属北京佑安医院血液净化中心,100069

出　　处：《肝脏》2021年第4期407-409,共3页Chinese Hepatology

基　　金：国家科技重大专项(2017ZX10203201-005);国家重点研发计划资助(2017YFA0103000)。

摘　　要：目的探讨人工肝治疗过程中同步检测动脉端管路血与外周静脉血凝血指标的价值。方法选取2018年3月至2018年8月在首都医科大学附属北京佑安医院行双重血浆分子吸附(DPMAS)治疗的肝病患者20例次,在固定的肝素抗凝给药方案下,同步采集动脉端管路血和外周静脉血标本进行凝血指标检测,比较两个部位凝血指标的差异。结果DPMAS治疗过程中20例次患者外周静脉血APTT为(103.6±44.7)s,动脉管路血为(105.2±54.2)s,差异无统计学意义(t=-0.973,P=0.331);在外周静脉血中有6例次出现APTT>400 s(未凝集状态),动脉端管路血中有5例次未凝集现象,对两组患者进行一致性检验分析,结果显示kappa系数为0.875(P<0.01),两组未凝集率一致。20例次DPMAS均顺利完成治疗,仅1例患者出现穿刺处渗血,4例患者因跨膜压增加而追加肝素。结论在人工肝治疗肝素抗凝相关研究中凝血指标的评价可以用动脉管路血替代外周静脉血;肝素方案还有待进一步研究评估及调整。Objective To analyze whether there are differences in coagulation indexes between arterial end-line blood and peripheral venous blood during artificial liver treatment.Methods Twenty patients with liver disease treated by dual plasma molecular sorption(DPMAS)in our hospital from March 2018 to August 2018 were selected.With fixed-dose heparin as anticoagulant,blood samples from arterial end pipeline and peripheral venous blood were collected simultaneously for the detection of coagulation indicators,and the differences of coagulation indicators between the 2 sites were compared.Results There was no significant difference in the coagulation indicators between arterial end-line blood and peripheral venous blood in the course of DPMAS treatment in 20 patients(P>0.05).The activated partial thromboplastin time(APTT)of peripheral venous blood was(103.6+44.7)s,which was consistent with that of arterial end-line blood(105.2+54.2)s(P>0.05).APTT was>400s(non-agglutinated state)in 30%of peripheral venous blood and 25%of arterial end-line blood.The consistency test of the 2 groups showed that the kappa coefficient was 0.875(P=0.000),and the non-agglutinated rate of the 2 groups was consistent.All of the 20 cases received DPMAS treatment successfully,1 patient experienced bleeding at the puncture site,and 4 patients were injected with more heparin due to increased transmembrane pressure.Conclusion During the artificial liver treatment,the coagulation indexes of arterial end-line blood can be used to represent that of peripheral venous blood in the study of heparin anticoagulation.The heparin regimen in this study needs further evaluation and adjustment.

关 键 词：人工肝 动脉管路血 外周静脉血 凝血指标 

分 类 号：R44[医药卫生—诊断学]