低血小板危重患者连续性血液净化的抗凝探讨

目的　探讨不同抗凝方法对伴有低血小板症的多脏器功能障碍综合征 (MultipleOrganDysfunctionSyndrome ,MODS)患者进行连续性血液净化时的抗凝效果。方法　将 12例伴有低血小板症的MODS患者进行的 5 4人次的连续性静静脉血液滤过 (CVVH)分为四组 :小剂量肝素组 (LDH)、低分子量肝素组 (LMWH)、无肝素 (NH)和小剂量低分子量肝素加盐水冲洗组 (COM) ,观察各组 12h内的抗凝效果、出血情况和血小板的变化。结果　NH组体外循环凝血发生率较其它组高 (P <0 .0 5 )。LDH组和LMWH组早期出血明显 ,NH组后期出血明显 ,COM组治疗前后则无明显变化 ,但与其它三组比较 ,COM组的出血次数明显减少 (P <0 .0 5 )。CVVH过程中 ,各组的凝血酶原活动度 (Pa)明显回升 (P <0 .0 5 ) ,除LDH组外 ,其它三组的血浆部分凝血活酶时间 (APTT)、凝血酶原时间 (PT)及凝血酶时间 (TT)逐渐降至正常。NH组血小板数下降显著 (P<0 .0 5 ) ,而肌酐清除不明显。结论　伴有低血小板症的MODS患者进行连续性血液净化时 ,小剂量低分子量肝素加盐水冲洗的抗凝效果较好、不增加出血危险、对血小板影响小

The effect of different anticoagulant methods in CVVH in critical patients with thrombocytopenia

Objective To investigate the effect of different anticoagulant methods in continuous venous-venous hemofiltration (CVVH) in critical patients with multiple organ dysfunction syndrome (MODS) and thrombocytopenia. Methods Fifty-four Person-times CVVH in 12 patients with MODS and thrombocytopenia were divided into four groups: low dose heparin group (LDH), low molecular weight heparin group (LMWH), no heparin group(NH), minor dose low molecular weight heparin and normal saline washing group (COM). Anticoagulant effect, bleeding and platelet were detected in each group within the first 12 hours CVVH. Results Blood coagulation in the extracorporeal circuit was more serious in NH than in other groups. Bleeding was more obvious in LDH and LMWH group in early time, while in NH gorup bleeding was more obvious in late time, no change in COM group, but bleeding were less in COM patients compared with other group. After CVVH, Prothrombin activity(Pa) was improved significantly in each group, active partial thromboplastin time(APTT), prothrombin time(PT) and thromboplastin time(TT) were normalized gradually in each group except LDH group. Comparing to the other three groups, platelets in NH group were reduced significantly,and the creatinine did not decrease obviously after 12h CVVH. Conclusion Anticoagulation with minor dose low molecular weight heparin and normal saline washing for the CVVH to the severe patients with MODS and thrombocytopenia was more effective, less bleeding and less impact on platelet.