低血小板危重患者连续性血液净化的抗凝效果比较及护理

目的　探讨两种抗凝方法对伴有低血小板的多脏器功能障碍综合征 ( MODS)患者在连续性血液净化治疗中的抗凝效果及护理。方法　将 1 2例低血小板的 MODS患者 3 6人次连续性静静脉血液滤过 ( CVVH)治疗中的抗凝方法分为两组 :无肝素组 ( NH组 )和小剂量低分子量肝素加盐水冲洗组 ( COM组 ) ,观察各组 1 2 h内的抗凝效果、出血情况、血小板的变化 ,总结护理措施。结果　 NH组出血例次较 COM组多 ( P<0 .0 0 5 ) ,两组体外循环凝血发生率无明显差异 ( P>0 .0 5 ) ;经 1 2 h治疗后 NH组血小板数下降显著 ( P<0 .0 5 ) ,而肌酐清除率低 ( P>0 .0 5 )。结论　伴有低血小板的 MODS患者CVVH治疗时采用小剂量低分子量肝素加盐水冲洗抗凝比无肝素抗凝效果好 ,对血小板影响小 ,不增加出血危险。良好的护理管理是治疗成功的重要保证

Effective comparisions and nursing on two anticoagulant methods during continuous venous-venous hemofiltration(CVVH) in serious patients with thrombocytopenia

Objective To investigate the effective comparability and nursing on two anticoagulant methods during continuous venous-venous hemofiltration(CVVH) in critical patients with multiple organ dysfunction syndrome(MODS) and thrombocytopenia.Methods Thirty-Six Person-times CVVH in 12 patients with MODS and thrombocytopenia were divided into two groups:no heparin group(NH) and minor dose low molecular weight heparin and normal saline washing group(COM).Anticoagulant effect,bleeding and platelet were detected in each group within the first 12 hours of CVVH.Results Bleeding was more obvious in NH group than that in COM group(P<0.05);Blood coagulation in the extracorporeal circuit in two group were no visible difference(P>0.05);platelets in NH group were reduced significantly(P<0.05);but the creatinine did not decrease obviously(P>0.05)after 12h of CVVH.Conclusion Anticoagulation with minor dose low molecular weight heparin and normal saline washing for the CVVH in the severe patients with MODS and thrombocytopenia is more effective and there is no effect to the bleeding and platelet.Good nursing is very important safeguard in cure process.