摘要
目的探讨改良式无肝素抗凝在高危出血倾向患者连续性静脉-静脉血液滤过(CVVH)应用中的可行性和安全性。方法采用自身对照法将36例具有高危出血倾向行无肝素CVVH治疗的患者按治疗单、双日分为观察组、对照组。对照组采用传统无肝素抗凝治疗64例次,观察组采用改良式无肝素抗凝治疗64例次。比较两组患者治疗前后临床指标变化、体外循环凝血及治疗后出血并发症情况。结果治疗前、后两组Hb、PT、APTT组内比较,差异无统计学意义(均P>0.05),而PLT和Fbg治疗前后比较,差异有统计学意义(均P<0.05)。两组间Hb、PT、APTT、PLT、Fbg比较,差异无统计学意义(均P>0.05)。两组滤器和静脉壶凝血情况比较,差异有统计学意义(均P<0.01)。两组无一例诱发或加重出血。结论对高危出血倾向患者行改良式无肝素CVVH治疗能起到安全有效的抗凝效果,还可降低滤器和静脉壶凝血发生率。
Objective To explore the feasibility and safety of modified heparin-free anticoagulation applied to patients at high risk of hemorrhage and receiving continuous venovenous hemofiltration（CVVH）. Methods Thirty-six participants at high risk of hemorrhage and receiving CVVH were enrolled in this self-control study,and they were treated with traditional heparin-free anticoagulation on an odd date（control group） and with modified heparin-free anticoagulation on an even date（observation group）.Both anticoagulation methods were studied for 64 times.Fluctuations of clinical parameters before and after treatment,extracorporeal coa-gulation and hemorrhage after treatment were compared. Results There were no statistical differences in Hb,PT and APTT before and after the treatment in both groups（P0.05 for all）,while PLT and Fbg had significant differences before and after the treatment in both groups（P0.05 for both）.The above-mentioned parameters showed no statistical differences between the two groups（P0.05 for all）.The occurrence rates of clots formed in the filter and venous chamber had significant differences between the two groups（P0.01 for both）.None of both groups developed bleeding. Conclusion Modified heparin-free anticoagulation is a safe and effective method for patients at high risk of hemorrhage and receiving CVVH,and it can reduce clots formed in the filter and venous chamber.
关键词
改良式无肝素抗凝
高危出血倾向
连续性静脉-静脉血液滤过
体外循环凝血
modified heparin-free anticoagulation
high risk of bleeding
continuous venovenous hemofiltration
extracorporeal coagulation
