肾功能衰竭合并严重出血患者的透析抗凝方法探讨

对３２例急慢性肾功能衰竭（肾衰）合并出血患者在活化全血凝固时间（ＡＣＴ）和肝素动力学严密监测下，根据临床出血危险性进行透析膜肝素处理高血液流量无抗凝剂透析和（或）个体化小剂量肝素透析。除１例外患者均安全渡过出血危险期。无抗凝剂透析法透析器凝血发生率为１５．５８％，未引起或加重出血。小剂量肝素化抗凝透析中ＡＣＴ延长控制在１０％～５０％，凝血发生率为４．５０％，加重出血发生率为１２．９６％。作者认为：活动性出血肾衰患者，特别是出血部位直接危及生命时，透析膜肝素处理结合高血液流量无抗凝剂血液透析是目前更安全的透析抗凝方法

Anticoagulation methods for high bleeding risk hemodialysis patients:Anticoagulantfree and precise control of minimal heparinization dialysis

e reported the successful use of anticoagulantfree and precisely controlled minimal heparinization techniques in 156 dialyses in 32 high bleeding risk patients with acute and chronic renal failure Fortyeight anticoagulantfree hemodialyses consisting of dialyzer priming heparin saline (50mg/500ml) combined with a high blood flow rate (300ml/min) were indicated for patients with very high and high bleeding risk Minimal heparinization dialysis was precisely controlled under heparin pharmacokinetic model guidance with the goal of achieving a sufficient concentration to prevent dialyzer clotting but not to result in an increased risk of patient bleeding The minimal heparinization was used in 108 dialyses in moderate and low bleeding risk patients Bleeding complications during and immediately following dialysis occurred in 14 of the 108 dialyses (12 96%) with minimal heparinization compared to zero of 48 anticoagulantfree dialyses (0) The incidence of dialyzer clotting was 4 50% and 15 58%respectively in minimal heparinization and anticoagulantfree dialyses Since this anticoagulantfree dialysis is a safe and effective hemodialysis method and requires no specialized equipment or procedures,it is a reasonable initial strategy for dialyzing very high bleeding risk patients with acute or chronic renal failure