双重血浆分子吸附系统治疗过程中肝素抗凝效果的影响因素研究

目的 观察经验性肝素抗凝方案在双重血浆分子吸附系统(double plasma molecular adsorption system, DPMAS)治疗过程中的抗凝效果与安全性,分析影响抗凝效果的因素。方法 选取2018年4月至2020年12月在首都医科大学附属北京佑安医院行DPMAS治疗的肝病患者102例,共进行治疗198次。根据DPMAS治疗过程中肝素抗凝效果分为抗凝良好组、抗凝不足组及抗凝过量组。比较不同的给药剂量组肝素抗凝效果良好例次的比例,比较3组患者基线临床资料的差异。结果 198例次均顺利完成治疗,其中抗凝良好组共118例次,抗凝不足组共11例次,抗凝过量组共69例次。当凝血酶原活动度(prothrombin activity, PTA)>30%、血小板计数(platelet, PLT)≤325×10⁹/L时,肝素抗凝效果良好例次的比例均＞70%;抗凝不良组患者体质量、血红蛋白(hemoglobin, Hb)、PLT显著高于抗凝良好组,差异有统计学意义(P<0.05);与抗凝良好组相比,抗凝过量组患者PTA、抗凝血酶活性(antithrombin activity, AT)、Hb降低,PT、APTT升高,差异有统计学意义(P<0.05);198例次治疗后24 h内,9例次患者出现中心静脉置管处渗血,1例次患者出现鼻腔出血,均未发生消化道出血等其他严重出血并发症;肝素过量组患者在治疗结束后24 h 活化部分凝血活酶时间(activated partial thromboplastin time, APTT)为(54.52±19.71) s,与治疗前比较,差异无统计学意义(P＞0.05)。结论 当患者PTA>30%、PLT≤325×10⁹/L时,DPMAS治疗中依据治疗前24 h内PTA和PLT给予不同肝素剂量是可行的,但应考虑体质量、血红蛋白对抗凝效果的影响。

Influencing factors of heparin anticoagulant effect in the treatment of double plasma molecular adsorption system

Objective To observe the anticoagulant effect and safety of empirical heparin anticoagulant regimen in the treatment of double plasma molecular adsorption system (DPMAS), and analyze the factors influencing the anticoagulant effect. Methods A total of 102 patients with liver disease treated by DPMAS in our hospital from April 2018 to December 2020 were selected, 198 times in total. According to the anticoagulation effect of heparin in the course of DPMAS treatment, they were divided into good anticoagulation group, insufficient anticoagulation group and excessive anticoagulation group. The proportion of cases with good anticoagulation effect in different dosage groups were compared, and the differences of baseline clinical data among the three groups were compared. Results There were 118 cases in good anticoagulation group, 11 cases in insufficient anticoagulation group and 69 cases in excessive anticoagulation group.When prothrombin activity (PTA)>30% and platelet (PLT)≤325×10⁹/L, the anticoagulant effect of heparin was good, and the proportion of cases was more than 70%. The body weight, hemoglobin(Hb) and PLT levels of patients with poor anticoagulation were significantly higher than those of patients with good anticoagulation (P<0.05). Compared with the good anticoagulant group, the levels of PTA, antithrombin activity(AT) and Hb in the excessive anticoagulant group were significantly lower, while the levels of PT and activated partial thromboplastin time(APTT) were significantly higher (P<0.05). Within 24 hours after 198 times of treatment, 9 patients had bleeding at the central venous catheter, 1 patient had nasal bleeding, and no other serious bleeding complications such as gastrointestinal bleeding occurred.The APTT level of heparin overdose group was (54.52±19.71)s at 24 hours after treatment, which was not significantly different from that before treatment. Conclusion When PTA>30% and PLT≤325×10⁹/L, it is feasible to give different doses of heparin according to PTA and PLT levels within 24 hours before treatment, but the influence of body weight and hemoglobin on anticoagulant effect should be considered.