不同抗凝技术在持续性静脉-静脉血液滤过中的效果评价

目的探讨不同抗凝技术在持续性静脉-静脉血液滤过（CVVH）治疗46例心脏术后急性肾功能衰竭患者过程中的抗凝效果.方法 46例患者中10例有出血倾向或出血危险性,设为A组,采用低分子量素钙加盐水冲洗进行抗凝,活动性出血12例,设为B组,采用无肝素抗凝技术,其余患者24例,设为C组,采用匀速同步体外肝素化.比较治疗前后血尿素氮（BUN）、肌酐（C）r、尿酸（UA）、电解质、酸碱指标、凝血指标;记录心率、平均动脉压、跨膜压及滤器寿命,总结护理措施.结果治疗后血Cr、BUN、UA、电解质均有统计学意义（P〈0.05）.整个治疗过程中,三组患者心率、平均动脉压均较稳定.跨膜压明显升高的时间点：B组〉A组〉C组.滤器平均寿命：C组〉A组〉B组（P〈0.01）.结论匀速同步体外肝素化体外抗凝效果较另外两种方法好,更能满足CVVH的抗凝要求,但对有明显活动性出血的患者前两种方法为首选。

Effect of Different Anticogulation Methods in Continuous Veno-venous Hemofiltration

Objective To explore the anticogulation effect of different anticoagulation methods in continuous veno-venous hemofiltration（CVVH） for 46 patients with acute renal failure after cardiac operation.Methods 46 patients were divided into three groups：A group,B group and C group.10 patients with hemorrhagic tendency or hemorrhagic risk in A group were given lowmolecular weight heparin and normal saline rinsing to anticoagulate.12 patients with active bleeding in B group were given heparin-free anticoagulation.Other 24 patients in C group were given uniform synchronous heparinization in vitro.Plasma levels of Cr,BUN,UA and electrolytes,acid and basic index,and coagulation index were compared between before and after treatment.The heart rate,mean arterial pressure,transmembrane pressure,and the mean life of filter were recorded,and the nursing measures were summarized.Results Plasma levels of Cr,BUN,UA and electrolytes decreased significantly after treatment in the three groups（P〈0.05）.The heart rate and mean arterial pressure of patients was stable during the treatment in the three groups.The time when the transmembrane pressure increased significantly：B group〉A group〉C group.The mean life of filter：C group〉A group〉B group.Conclusions Uniform synchronous heparinization in vitro has better anticoagulation effect than low molecular weight heparin and normal saline rinsing and heparin-free anticoagulation,and is more suitable in CVVH.However,the other two anticoagulation methods are the first choice for patients with obvious active bleeding.