TT和APTT联合应用指导成人ECMO支持患者肝素抗凝管理的临床研究  

Application of TT and APTT in guiding the management of heparin anticoagulation in adult patients treated with ECMO

作　　者：沈建国 马丽英 陈云 刘志昱 张军 SHEN Jianguo;MA Liying;CHEN Yun;LIU Zhiyu;ZHANG Jun(Blood Center of Qingpu District,Shanghai 201700,China;Department of Transfusion Medicine,Shanghai Deltahealth Hospital,Shanghai 201702,China)

机构地区：[1]上海市青浦区血站,上海201700 [2]上海德达医院输血科,上海201702

出　　处：《检验医学与临床》2023年第2期203-206,共4页Laboratory Medicine and Clinic

摘　　要：目的评估在成人体外膜肺氧合(ECMO)治疗期间,通过凝血酶时间(TT)和活化部分凝血活酶时间(APTT)联合检测来综合判断肝素浓度及体内抗凝效果,为ECMO治疗患者提供恰当的抗凝管理。方法选取26例静脉-动脉ECMO治疗患者作为研究对象,监测其凝血相关指标:活化凝血时间(ACT)、TT、APTT、抗Xa因子,并分析它们之间的相关性。结果TT与抗Xa因子的相关性较强(r=0.901,P<0.001)。APTT、ACT与抗Xa因子的相关性中等(r=0.566、0.540,P<0.001)。APTT与ACT的相关性较强(r=0.864,P<0.001)。TT与APTT、ACT的相关性弱(r=0.297、0.321,P=0.001、<0.001)。结论TT与低浓度肝素有良好的正相关性,ECMO治疗期间,TT和APTT联合应用可以较好地反映肝素浓度的变化及抗凝效果,可为临床指导肝素的剂量及输血提供较好的依据。Objective To evaluate the combined detection of thrombin time(TT)and partial thromboplastin time(APTT)in comprehensively judging heparin concentration and anticoagulant effect in vivo for adult patients treated with extracorporeal membrane oxygenation(ECMO),so as to provide appropriate anticoagulation management for patients.Methods Activated clotting time(ACT),TT,APTT,anti-factor Xa were detected in 26 patients supported with venoarterial ECMO,and the correlation was analyzed.Results A good positive correlation was obtained between TT and anti-factor Xa(r=0.901,P<0.001).APTT and ACT showed a moderate correlation with anti-factor Xa(r=0.556,0.540,P<0.001).A good positive correlation was observed between APTT and ACT(r=0.864,P<0.001),while TT had a weak correlation with APTT and ACT(r=0.297,0.321;P=0.001,P<0.001).Conclusion TT has a strong positive correlation with the lower concentration of heparin.The combination of TT and APTT can better reflect the changes of heparin concentration and anticoagulant effect during ECMO therapy,which can guide the adjustment of the heparin dosage and transfusion of blood products.

关 键 词：体外膜肺氧合 凝血酶时间 活化部分凝血活酶时间 活化凝血时间 抗XA因子 肝素 

分 类 号：R459.7[医药卫生—急诊医学]