两种不同抗凝药物在组合型人工肾治疗中的对照

背景：组合型人工肾可以全面清除尿毒症患者体内的各种毒素,预防和治疗透析长期并发症,但透析器和/灌流器凝血是困扰医生和患者的一大问题。目的：观察两种不同抗凝方案在组合型人工肾（血液灌流＋血液透析）治疗慢性肾衰竭患者中的抗凝效果及安全性。方法：分别应用肝素钠和低分子肝素钠对35例行组合型人工肾治疗的慢性肾衰竭患者按原抗凝方案的1.5~2.0倍进行抗凝各4周,观察并比较两种不同抗凝药物的抗凝效果及出血情况,对比治疗前、治疗4周、治疗8周的凝血酶原时间、活化部分促凝血酶原激酶时间、凝血酶时间、血小板及血红蛋白的变化。结果与结论：应用肝素时发生滤器及灌流器凝血1级2例、2级1例,应用低分子肝素时发生滤器及灌流器凝血1级3例、2级2例,两组均未发生3级滤器及灌流器凝血;应用肝素时出现出血1级12例、2级3例,应用低分子肝素时出现出血1级2例、2级1例;应用肝素后血小板减少,活化部分促凝血酶原时间延长,与治疗前比差异有显著性意义;应用低分子肝素后各检验指标变化不大,差异均无显著性意义（P〉0.05）。结果显示慢性肾衰竭患者行组合型人工肾治疗时,低分子肝素和肝素抗凝效果接近,低分子肝素出血并发症少。

Two different anticoagulant protocols for treatment of combined-type artificial kidney

BACKGROUND： Combined-type artificial kidney can completely get rid of various toxins in uremia patients, prevent and treat long-term complications caused by dialysis. But dialyzer and perfusion instrument blood coagulation trouble physicians and patients. OBJECTIVE： To investigate the anticoagulant effects and safety of two different anticoagulant protocols in treatment of chronic renal failure in combined-type artificial kidney. METHODS： Heparin sodium and low molecular heparin sodium was used for 4-week anticoagulation in chronic renal failure patients who received combined-type artificial kidney （hemoperfusion＋hemodialysis） at the amount of 1.5-2.0 times of original anticoagulant protocols. Anticoagulant effects, hemorrhage, prothrombin time, partial thromboplastin time, thrombin time, blood platelet and hemoglobin levels before treatment, 4 and 8 weeks after treatment were compared between two different anticoagulant drugs. RESULTS AND CONCLUSION： When heparin sodium was used, grade 1 blood coagulation appeared in two cases and grade 2 blood coagulation in one case. When low molecular heparin sodium was used, grade 1 blood coagulation appeared in three cases and grade 2 blood coagulation in two cases. Grade 3 blood coagulation was not observed when heparin sodium or low molecular heparin sodium was used. When heparin sodium was used, grade 1 hemorrhage was observed in 12 cases and grade 3 hemorrhage in three cases. When low molecular heparin sodium was used, grade 1 hemorrhage was observed in two cases and grade 2 hemorrhage in one case. After heparin sodium application, blood platelets were reduced, partial thromboplastin time was prolonged, and there was no significant difference compared with before treatment. There was no significant difference in each index between before and after low molecular heparin sodium application （P 0.05）. These results showed that in combined-type artificial kidney treatment in chronic renal failure patients, low molecular heparin sodium and heparin sodium show similar anticoagulant effects, and low molecular heparin sodium exhibits fewer complications.