普通肝素抗凝时高岭土-血栓弹力图R时间目标值研究

目的探讨普通肝素抗凝时，高岭土-血栓弹力图R时间目标值。方法检测不同浓度肝素时血液aPTT和R时间。检测15例（21例次）肝素抗凝患者的高岭土-血栓弹力图R时间和肝素酶-血栓弹力图△R％，比较R时间和△R％判断肝素抗凝效果。结果肝素浓度在0-0．5u／ml，与aPTT、R时间均呈直线相关（P〈0．01）。aPTT为正常值2倍时，肝素浓度为0．10-0．22u／ml，肝素浓度在此范围内的R时间为13．9-22．3min。21例次肝素抗凝患者R时间为7．7±3．4min。肝素酶-血栓弹力图△R％为4．0±19．3％。R时间和肝素酶△R％判断肝素抗凝效果符合率为85．7％，无明显差别（P〉0．05）。结论肝素治疗并达到抗凝效果时，高岭土-血栓弹力图R时间目标值为13．9～22．3min（取整数14-22min），约为R时间正常上限的1．5-2倍（R时间正常值为5-10min）。

The Target Value of Kaolin-thromboelastography R Time for Anticoagulation Therapy with Unfractionated Heparin

Objective To explore the target value of kaolin-thromboelastography R time for anticoagu- lation therapy with unfractionated heparin. Methods Activated partial thromboplastin time （aPTF） and kao- lin- thromboelastography R time were detected when different concentration of unfractionated heparin was add- ed to venous blood. 21 times of kaolin-thromboelastography and heparinase-modified thromboelastography were conducted in 15 patients treated with heparin. The consistence rate of kaolin-thromboelastography R time and heparinase-modified thromboelastography △ R % for evaluating the anticoagulation effect of heparin was com- pared. Results When the concentration of heparin was within 0 - 0.5 u/ml, there is a positive correlation be- tweena PTT and heparin concentration （P 〈0.01 ） , as well as between R time and heparin concentration （P 〈 0.01 ）. When aPTT was 2 times normal value as often used clinically as the target value of antieoagulation with heparin,the concentration of heparin was 0.10 - 0.22 u/ml,and the R time was 13.9 -22.3 rain. The R time was 7.7 ± 3.4 rain,△ R % was 4.0 ± 19.3 % in 15 patients （21 times）. No significance was seen for the evaluation of heparin anticoagulation effect using kaolin-thromboelastography R time and heparinase-modi- fied thromboelastography △ R %, with consistence rate being 85.7% （P 〉 0.05）. Conclusion In anticoagulant therapy with unfracfionated heparin ,the target value of kaolin-thromboelastography R time was 13.9- 22.3 min（14 -22 min as integer） ,which is about 1.5 -2 times upper normal value（normal R time is 5 - 10 min）.