透析前注射单剂量低分子量肝素对透析器复用效率的评价

目的：评价血液透 析前注射单剂量低 分子量肝素（ Ｌ Ｍ Ｗ Ｈ）与持续 输注普通肝素（ Ｓ Ｈ）对复用透析器 效率的影响。方法：对 ３０ 例慢性透 析患者进行随机交叉对照研究，观察第一、四次透析的透析器纤维包裹容量 （ Ｆ Ｂ Ｖ）、透析前血球压积 （ Ｈ Ｃ Ｔ）及透析 ２ ｈ 尿素氮、肌酐 清除率，另外，利用生色底物法测定透析 ０ ｈ、２ ｈ、４ｈ 血浆肝素抗 Ｆｘａ 水平。结果：同 Ｓ Ｈ 组比， Ｌ Ｍ Ｗ Ｈ 组透析器复用次数明显增加（ Ｐ＜ ０．０５），第四次复用透析器 Ｆ Ｂ Ｖ 及透析 ２ ｈ 尿素氮、肌酐清除 率无明显 下降（ Ｐ＜ ０．０５）， Ｓ Ｈ 组则明显 下降（ Ｐ＜ ０．０５），透析 ２ ｈ 两组血浆肝素活性抗 Ｆｘａ 水平无明显差异（ Ｐ＜ ０．０５），透析 ４ ｈ Ｌ Ｍ Ｗ Ｈ 组明显高于 Ｓ Ｈ 组（ Ｐ＜ ０．０５）。结论：透析前 单剂量注射 Ｌ Ｍ Ｗ Ｈ 能保护复用透析器清 除率，值得临床上进一步推广。

Evaluation on efficiency of low molecular weight heparin as asingle bolus dose with reused dialyzers

Objective:To evaluate the efficiency of low molecular weight heparin (LMWH)given as a single predialysis bolus injection with reused dialyzers in comparison with standard heparin (SH) administered with a continuous inffusion.Methods:30 hemodialysis patients were studied in a radomized crossover fashion.Dialyzers fibrer bundle volumes (FBV),predialysis hemocrit,2 h clearance of urea,creatinine were observed in first,fourth dialysis;The plasma heparin activity (anti Fxa levels)were measured by the chromogenic substrate assay in 0 h,2 h,4 h of diabysis.Our results showed that A significant(P<0.05)increase was seen in the number of dialyzer reuse in the LMWH group compareed with SH group.Results:There were not significantly(P<0.05)decreased in dialysis FBV as well as 2 h clearance of urea,creatinine.In addition,the plasma heparin activity (anti Fxa levels)were comparable in both groups after 2 h of dialysis.However,they were significantly(P<0.05)higher after 4 h in the LMWH than in the SH group.Conclusion:LMWH as a single bolus dose can prevent a decrease in dialyzer clearance,it is clinically worthy of further popularity.