局部体外肝素、无肝素及低分子肝素抗凝在有出血倾向的血液透析中的对比研究

目的]探讨局部体外肝素、无肝素及低分子肝素抗凝在有出血倾向的血液透析中应用的安全性和有效性.方法]选择伴有中、高危出血倾向的血透患者22例,随机分为局部体外肝素组6例,无肝素组8例,低分子肝素组8例.观察出血情况的变化,计算eKt/V值,记录血流量、超滤量、每小时监测透析器跨膜压(TMP),观察透析器凝血程度及透析...

Comparison of anticoagulation using regional heparin,heparin-free and low molecular weight heparins in hemodialysis patients with high risk of bleeding

Objective] To assess the efficacy and safety of regional heparin,heparin-free and low molecular weight heparin(LMWH) anticoagulation in hemodialysis patients with high risk of bleeding.Methods] Twenty-two patients were randomized in this study and divided into three groups,six patients in regional heparin group,eight patients in heparin-free group and eight patients in LMWH group.The incidence of bleeding and the dialyser coagulation as well as Activated Partial Thromboplastin Time(APTT) and the platelet count were observed at the baseline and after hemodialysis.Hemodialysis parameters including eKt/V,vascular flow rate,ultrafiltration and transmembrane pressure(TMP) were also documented.Results] Every group performed forty hemodialysis sessions.The incidence of bleeding was 5%,5% and 12.5%(P<0.05) in the three groups.eKt/V value was 1.25±0.41,1.19±0.23 and 1.22±0.35(P>0.05) respectively.GradeⅠcoagulation of dialyser was 5%,20% and 10%(P<0.05).Ultraliftration,vascular flow rate and TMP in heparin-free group significantly increased,compared with the other two groups(P<0.05).APTTs at the baseline and after hemodialysis in LMWH group were(33±4) s and(45±5) s(P<0.05).There was no change in APTT and the platelet count between the baseline and hemodialysis in the other two groups.Conclusion] In hemodialysis patients suffering from high risk of bleeding,the all three methods of anticoagulation show the satisfactory efficiency.In comparison with the two other groups,regional heparin anticoagulation is a safe and feasible alternative.