血浆吸附治疗肝衰竭肝素抗凝方案的临床研究  

Clinical study of heparin anticoagulation scheme during plasma adsorption therapy for liver failure

作　　者：闫国胜 张宏涛 鲁杨 朱桂珍 毛小欢 Yan Guosheng;Zhang Hongtao;Lu Yang;Zhu Guizhen;Mao Xiaohuan(Department of Blood Purification Center,Henan Provincial People's Hospital,Henan Key Laboratory for Nephropathy Immunity,Zhengzhou University People's Hospital.Zhengzhou 450003,China;Department of Clinical Laboratory,Henan Provincial People's Hospital,Zhengzhou University People's Hospital.Zhengzhou 450003,China)

机构地区：[1]河南省人民医院血液净化中心河南省肾脏病免疫重点实验室郑州大学人民医院,郑州450003 [2]河南省人民医院检验科郑州大学人民医院,郑州450003

出　　处：《中华肝脏病杂志》2022年第7期716-721,共6页Chinese Journal of Hepatology

摘　　要：目的探讨人工肝血浆吸附(PA)治疗肝衰竭时合理的肝素剂量与抗凝方案。方法回顾性收集PA治疗的肝衰竭患者,根据抗凝方式分为首剂肝素抗凝组和首剂加维持肝素抗凝组。比较两组患者临床资料和治疗前后实验室检查结果。符合正态分布者组内比较用配对t检验,两组间比较采用两独立样本t检验,不符合正态分布的计量资料采用Wilcoxon秩和检验。计数资料组间比较采用Fisher确切概率法。结果2017年10月至2020年9月PA治疗的肝衰竭患者138例,其中首剂肝素抗凝组83例,首剂加维持肝素抗凝组55例。两组患者年龄、性别、治疗前实验室资料可比。两组患者均顺利完成PA治疗,血浆分离器凝血等级判定比较差异无统计学意义(Z=-0.15,P=0.216);两组均存在不同程度出血并发症,其中首剂肝素抗凝组中心静脉导管渗血2例(2.4%)、鼻腔出血1例(1.2%),首剂加维持肝素抗凝组中心静脉导管渗血5例(9.1%)、皮肤出血点2例(3.6%)、鼻腔出血1例(1.8%)、上消化道出血1例(1.8%),首剂肝素抗凝组出血并发症发生率低于首剂加维持肝素抗凝组,差异有统计学意义(P<0.001);两组患者PA治疗后活化部分凝血活酶时间较PA治疗前均延长,差异有统计学意义(首剂肝素抗凝组:t=3.850,P=0.022;首剂加维持肝素抗凝组:t=6.733,P=0.007)。首剂加维持肝素抗凝组患者下机时活化部分凝血活酶时间较首剂肝素抗凝组延长,差异有统计学意义(P=0.025);两组患者PA治疗前后总胆红素明显变化(首剂肝素抗凝组:Z=-2.455,P=0.017;首剂加维持肝素抗凝组:Z=-2.307,P=0.024)差异均有统计学意义;两组间变化比较,差异无统计学意义(P=0.412);两组患者PA前后血小板变化差异无统计学意义(首剂肝素抗凝组:Z=-0.529,P=0.480;首剂加维持肝素抗凝组:Z=-0.276,P=0.362)。结论对于治疗前20%≤凝血酶原活动度≤40%、活化部分凝血活酶时间≤87 s(正常上限值2倍)、血小板≥Objective To investigate the reasonable dosage of heparin anticoagulation scheme during plasma adsorption(PA)therapy for liver failure.Methods Patients with liver failure treated with PA therapy were retrospectively collected and divided according to the anticoagulation scheme into the first-dose heparin anticoagulation group and the first-dose plus maintenance heparin anticoagulation group.Clinical data and laboratory test results were compared before and after treatment between the two groups.Paired t-tests were used for comparison within the normally distributed groups.An independent two-sample t-test was used for inter group comparison.Wilcoxon rank-sum test was used for measurement data that did not conform to a normal distribution.Fisher's exact test was used to compare the count data between groups.Results There were 138 cases with liver failure treated with PA therapy from October 2017 to September 2020.Among them,83 and 55 cases were in the first-dose heparin anticoagulation and first-dose plus maintenance heparin anticoagulation group,respectively.Age,gender,and laboratory data before treatment were comparable between the two groups.PA treatment was successfully completed in both groups of patient,and there was no statistically significant difference in the determination of coagulation level with plasma separators(Z=-0.15,P=0.216).There were different degrees of bleeding complications in both groups.In the first-dose heparin anticoagulation group,there were two cases(2.4%)of central venous catheter bleeding and one case(1.2%)of epistaxis.In the first-dose plus maintenance heparin anticoagulation group,there were five cases(9.1%)of central venous catheter bleeding,two cases(3.6%)of skin bleeding,one case(1.8%)of epistaxis,and one case(1.8%)of upper gastrointestinal bleeding.The incidence of bleeding complications was lower in the first-dose of heparin anticoagulation than first-dose plus maintenance heparin anticoagulation group,and the difference was statistically significant(P<0.001).The activated part

关 键 词：人工肝 血浆吸附 肝素 抗凝剂 

分 类 号：R575.3[医药卫生—消化系统]