比较肝素酶修饰的血栓弹力图与APTT用于血液净化时肝素监测的临床研究

目的 研究肝素酶修饰的血栓弹力图(hmTEG)用于连续性肾脏替代治疗(CRRT)时肝素监测的临床价值。方法 选取2014年1月至2019年6月解放军第九〇八医院重症医学科进行血液净化治疗时用肝素抗凝的97例患者，总血液净化台次为278,依据血液净化抗凝时采用部分活化凝血酶原时间(APTT)监测或hmTEG监测，将患者分为APTT组和TEG组，比较两组患者血液净化前及第28天SOFA、血液净化总时间、肝素总剂量、滤器寿命与出血并发症情况，并进行生存分析。结果 与APTT组相比，TEG组的肝素总剂量明显增加、血液净化时间和平均滤器寿命明显延长(P<0.05);与APTT组的第28天SOFA相比，TEG组的SOFA明显更低(P<0.05);生存分析显示，APTT组患者的28天死亡风险是TEG组的2.01倍(P<0.05),TEG组的72 h滤器寿命较APTT组明显长(P<0.05)。结论 用hmTEG监测血液净化时的肝素抗凝更安全且可以延长滤器使用寿命，改善病情及病死率。

Clinical research on heparin monitoring blood purification: comparison of heparinase-modified thromboelastography versus activated partial thromboplastin time ( APTT) in continuous renal replacement therapy for critically ill patients

Abstract : Objective To investigate the clinical values of heparinase-modifed thromboelastography ( hmTEG )in heparin monitoring during continuous renal replacement therapy. Methods A total of 97 cases who were undergoing continuous renal replacement therapy ( CRRT) in the intensive care unit of the 94th People''s Liberation Army Hospital from Jan 2014 to Jun 2019 were enrolled in this study. The patients were divided into TEG group and APTT group according to different means of heparin monitoring during continuous renal replacement therapy. In total, 278 hemofiters were used in all the blood purification therapies. Complication of bleeding, CRRT time, total heparin dose and SOFA ( sequential organ failure assessment) score of the patients were compared between the TEG and APTT groups. The filter life span and survival time in hospital were also compared using Kaplan-Meier analysis. Rusults Compared with APTT group , the total heparin dose in TEG group were significantly higher (P<0.05). The CRRT time of patients and the average filter life span in TEG group were significantly longer than those of APTT group ( P<0.05). Compared to APTT group ,the 28-day SOFA in TEG group was significantly lower ( P<0.05). Survival analysis showed that the 28-day risk of death in the patients of APTT group was 2.01 times higher than that in TEG group ( P<0.05). The 72-hour filter life of TEG group was significantly longer than that of APTT group (P<0.05 ). Conclusion The use of hmTEG for monitoring heparin in blood purification should be supenior in terms of safety and efficacy with longer filter life span and higher survival rate of patients.