低分子肝素对腹膜透析患者腹膜功能影响的观察

目的探讨低分子肝素对腹膜透析患者腹膜通透性、腹膜超滤量的影响。方法选择病情稳定的腹膜透析患者22例,采用双盲交叉对照设计,将患者随机分成2组,分别于腹膜透析液中加入低分子肝素和生理盐水,治疗3个月,再经1个月的洗脱期后交换处理因素,分别观察患者的腹膜通透性、超滤量及各凝血指标的变化。结果低分子肝素处理期,透析液肌酐／血肌酐和透析液尿素／血尿素比值较处理前和生理盐水处理期均明显降低,差异均有统计学意义（P〈0．05）。低分子肝素处理期透析液白蛋白／血白蛋白比率较处理前和生理盐水处理期明显降低,差异均有统计学意义（P〈0．05）。低分子肝素处理期4h、0h透析液葡萄糖比率及24h超滤量均较处理前和生理盐水处理期明显升高,差异均有统计学意义（P〈0．05）。所有患者观察期间均未出现腹腔出血并发症。结论腹膜透析患者腹膜透析液中加入低分子肝素可降低腹膜小分子的通透性,增加腹膜超滤量,而不增加出血的风险。

The effects of low-molecular weight heparin on peritoneal function in peritoneal dialysis patients

Objective To investigate the influence of low-molecular weight heparin on peritoneal permeability and ultrafiltration in peritoneal dialysis patients. Methods By means of a double-blinded cross-over design, 22 peritoneal dialysis patients were randomized to receive either normal saline or low-molecular weight heparin intraperitoneally for 2 treatment periods of 3 months, separated by a wash-out period of 1 month. Low-molecular weight heparin was added to peritoneal dialysate to ob- serve the change in permeability, ultrafiltration and bleeding risk of peritoneal membrane. Results Intraperitoneal low-molecular weight heparin significantly reduced the dialysate-to-plasma ratios of creatinine, urea and albumin （P〈0. 05）. In addition, the ratio of glucose concentration in dialysate at 4 h dwell to that of 0 h dwell was increased （P〈0. 05） along with an increase in ultrafiltration volume （P 〈0. 05）. There were no bleeding complications. Conclusions Intraperitoneal low-molecular weight heparin reduces peritoneal permeability to small solutes and increases ultrafiltration in peritoneal dialy- sis patients, without adding to bleeding risk.