低分子量肝素在血液透析应用中的评价

目的：比较低分子量肝素与普通肝素在常规血液透析抗凝中的有效性和安全性。方法：40例血液透析患分别用低分子量肝素和普通肝素抗凝进行自身对照，并作低分子肝素组与普通肝素组的组间对照。观察透析器及透析管道的凝血状态，内瘘穿刺点的压迫止血时间，抗因子Xa活性(AFXa)、凝血酶时间(TT)和活化部分凝血活酶时间(APTT)。结果：两组患均能顺利完成5小时透析，透析器及透析管道凝血程度及穿刺点压迫止血时间两组均无显差异(P＞0．05)。两组患使用低分子肝素抗凝透析结束时AFXa较血液透析前有显性差异(P＜0．001)，且透析开始后30分钟及透析结束时均明显高于普通肝素组，而APTT、TT在LMWH抗凝过程中无显延长，而普通肝素组则明显延长。结论：低分子量肝素在血液透析抗凝过程中较之普通肝素更有效，安全，方便，可替代普通肝素。

Evaluation of low molecular weight heparin in hemodialysis

Objective To Compare the anticoagulation efficiency and safety of low molecular weight heparin (LMWH) with unfractionated heparin (UFH) in hemodialysis. Methods Fourty hemodialysis patients were studied in a radomized crossover study to compare LMWH given as a single predialysis bolus injection with UFH administered with a continuous infusion , and these paitents were divided into group A and B. The data include clot formation in the dialyzer and tube, the pressure time at the puncture sife, anti - Fed levels (AFXa), activated partial thromboplastin time ( APTT) and thrombin time (TT). Results the two group all finished the hemodialytic course. Compared with the UFH, there were no significant difference of the clot formation in the extracorporeal circuit and the pressure time at the puncture sites. The AFXa levels were significantly higher after hemodialysis than before in the LMWH group, and significantly higher after 30 min and at the finished time in the LMWH group than in the UFH group.There were no significant prolongat in APTT and TT levels in the LMWH group, whereas there were markedly prolongation in the UFH group, and part of hemodialysis times were uncoagulated. Conclusion The results showed that a single dose of LMWH was an effective, safe and convenient alternative to UFH.