应用血栓弹力图评价血液透析患者低分子肝素剂量的研究

目的探讨应用血栓弹力图评价血液透析患者低分子肝素剂量的临床研究。方法选取2018年1月至2019年8月在广东省佛山市三水区人民医院进行血液透析患者200例,根据低分子肝素应用总量不同分为对照组(高剂量组,总量≥80U/kg体重)和研究组(低剂量组,总量<80U/kg体重),分别在透析前、透析3h及透析完成24h时段对两组患者活化部分凝血活酶时间(activated partial thromboplastin time,APTT)及血栓弹力图指标进行对比分析,比较两组抗凝效果,对比两组静脉压、跨膜压等指标变化情况,通过监测患者血浆尿素浓度对透析效果进行评价。结果与对照组比较:患者透析前APTT检测结果差异无显著性(P>0.05),血栓弹力图检测中R值、MA值、K值、CI值结果差异无显著性(P>0.05);透析3h后,两组患者APTT明显延长且差异无显著性(P<0.05),研究组R值、MA值、K值、CI值较对照组差异有显著性(P<0.05);透析完成24h后,两组APTT明显延长且差异有显著性(P<0.05),研究组APTT小于对照组;透析患者低分子量肝素剂量与患者体重的ROC曲线下面积为0.68时即可达到充分抗凝效果;研究组较对照组出血倾向低,差异有显著性(P<0.05),两组静脉压、跨膜压、透析效果比较差异无显著性(P>0.05)。结论血栓弹力图指标更能反映透析患者凝血实时功能,低分子肝素小剂量应用即可达到充分抗凝且不影响透析效果,透析患者使用小剂量低分子量肝素出血风险更低。

Clinical study on the evaluation of the dose of low-molecule-weight heparin for hemodialysis patients by thromboelastography

Objective To investigate the clinical study on the evaluation of the dose of low-molecule-weight heparin for hemodialysis patients by thromboelastography.Methods A total of 200 patients with hemodialysis were enrolled in our hospital from January 2018 to August 2019,who were divided into the control group(high-dose group,total≥80 U/kg)and the study group(low-dose group,total≤80 U/kg)according to the total amount of low-molecular-weight heparin.The activated partial thromboplastin time(APTT)and thromboelastography indexes were compared between the two groups before dialysis,dialysis for 3 hours,and dialysis for 24 hours to evaluate the anticoagulant effect and the changes of venous pressure and transmembrane pressure.The concentration of the plasma urea were monitored to evaluate the dialysis effect.Results APTT values were no significant different compared with the control group before dialysis(P>0.05).There was no significant difference in R,MA,K and CI values in thromboelastography(P>0.05).APTT values was significant prolonged in the two groups but there was statistical difference(P<0.05)after 3 hours,.The R、MA、K and CI value in the study group were statistical different from the control group(P<0.05);the APTT values of the two groups was significant prolonged and statistically significant(P<0.05)after 24h as dialysis was completed.The APTT values of the study group was smaller significant than that of the control group.The SPSS 19.0 software analysis showed that the area under the ROC curve(AUC)of the dose of low-molecularweight heparin and the patient’s body weight in the dialysis patients was 0.68,that sufficient anti-coagulant effect was achieved;the bleeding tendency in the study group was lower than that in the control group,the difference was statistically significant(P<0.05).The venous pressure,transmembrane pressure,and the dialysis effect were no statistical difference in the two groups(P>0.05).Conclusion The thromboelastography index can reflect the real-time function of clotting in dialysis patients.Low dose of low-molecular-weight heparin can achieve sufficient anti-coagulation and didn’t affecting dialysis effect.The risk of dialysis patients using low dose low-molecular-weight heparin is lower.