改良肝素抗凝方案在儿童血液灌流治疗中的抗凝效果及安全性评价  

Anticoagulant effectiveness and safety evaluation of a modified heparin anticoagulant method in children treated with hemoperfusion

作　　者：张胜华[1,2,3] 郭慧 陈秀英[1,2,3] Zhang Shenghua;Guo Hui;Chen Xiuying(Department of Pediatric Nephrology,West China Second Universily Hospital,Sichuan University,Chengdu 610041,Sichuan,China;West China School of Nursing,Sichuan University,Chengdu 610041,Sichuan,China;Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University),Ministry of Education,Chengedu 610041,Sichuan,China)

机构地区：[1]四川大学华西第二医院小儿肾脏科,四川成都610041 [2]四川大学华西护理学院,四川成都610041 [3]出生缺陷与相关妇儿疾病教育部重点实验室,四川成都610041

出　　处：《中国中西医结合急救杂志》2023年第5期588-591,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的观察改良后的肝素抗凝方案和标准肝素抗凝方案在血液灌流治疗中的抗凝效果及安全性,为优化血液灌流治疗的抗凝方案提供依据.方法采用便利抽样法选择2021年6月至2022年2月在四川大学华西第二医院小儿肾脏科接受血液灌流治疗的23例患儿作为研究对象,共行41例次治疗.按肝素抗凝方案不同将患儿分为标准抗凝方案组和改良抗凝方案组.标准抗凝方案组11例患儿行19例次治疗,使用标准的肝素抗凝方案,即血液灌流治疗前静脉使用首剂肝素0.5~1.0 mg/kg,于上机前5~10 min给予,继以0.2~0.5 mg·kg^(-1)·h^(-1)持续静脉输注,预计结束前30 min停止.改良抗凝方案组12例患儿行22例次治疗,实施改良后的肝素抗凝方案,即治疗开始前静脉推注肝素1 mg/kg,后不再追加.观察两组患儿治疗30、60、90 min及治疗结束时活化部分凝血活酶时间(APTT)的变化和两组管路、滤器凝血以及患儿出血情况,并比较治疗结束后1h两组APTT的恢复情况和血小板计数(PLT)水平.结果治疗30、60、90 min及治疗结束时两种抗凝方案均能达到抗凝效果,但改良抗凝方案较标准抗凝方案APTT值超过300 s的概率低68.8%[β=-1.166,优势比(OR)=0.312,95%可信区间(95%CI)为0.125~0.775,P=0.012],更加安全;肝素对患儿的抗凝效果不受性别(P=0.179)及年龄(P=0.821)的影响;治疗结束后1h改良抗凝方案组APTT的恢复比例明显高于标准抗凝方案组(11/22比3/19,P<0.05).两种抗凝方案在治疗过程中均未出现管路和滤器凝血,治疗结束24h内患儿均无活动性出血.结论改良后的抗凝方案能达到与标准方案相当的抗凝效果,且更安全,同时简化了操作流程,可降低血源性感染风险.Objective To examine the anticoagulant effectiveness and safety of a modified heparin anticoagulant method with those of the standard hepair anticoagulant method in children treated with hemoperfusion,and to provide a basis for optimizing the anticoagulant protocol of hemoperfusion treatment.Methods Twenty-three children treated with a total of 41 sessions of hemoperfusion from June 2021 to February 2022 in Department of Pediatric Nephrology of West China Second Hospital of Sichuan University were selected as research objects by convenient sampling method.The participants were divided into a standard anticoagulation group and an improved anticoagulation method group according to the different heparin-anticoagulation schemes.A total of 11 children in the standard anticoagulation group received 19 sessions of hemoperfusion treatment using the standard heparin anticoagulation scheme,i.e,the first dose of 0.5-1.0 mg/kg heparin was given intravenously,5-10 minates before hemoperfusion,followed by continuous intravenous infusion of 0.2-0.5 mg·kg-1·h-1 heparin which was expected to be stopped 30 minutes before the ending of hemoperfusion.A total of 12 patients in the improved anticoagulation method group underwent 22 sessions of hemoperfusion treatment using an improved heparin anticoagulant method,ie,intravenous injection 1 mg/kg of heparin before the start of treatment without additional administrations of heparin thereafter.The changes in activated partial thromboplastin time(APTT)at 30,60,90 minutes,and the end of treatment in two groups of children,as well as the coagulation status of the two groups of pipelines and filters,together with the bleeding situation of the children,were monitored.The differences in platelet count(PLT)and recovery of APTT 1 hour after treatment between the two groups of children were compared.Results Compared with the standard anticoagulation method,the improved anticoagulation method showed 68.8%lower APTT value exceeding 300 seconds[β=-1.166,odds ratio(OR)=0.312,95%confidence interva

关 键 词：血液灌流 血液净化 肝素 抗凝 

分 类 号：R457.3[医药卫生—治疗学]