两种低分子肝素和肝素钙在血液透析中抗凝效果对比研究

目的观察速避凝和法安明两种低分子肝素在血液透析中抗凝效果。方法选择39例常规血液透析患者，随机分3组，分别使用肝素钙、法安明和速避凝抗凝进行血液透析2次。观察透析结束后出血、透析器凝血情况，测量透析器容量及KT/V值，同时检测透析前，透析后30分钟、2和4小时部分凝血酶原时间（APTT）、凝血酶原活动度（PA）、凝血酶原时间（PT）、凝血酶凝固时间（TT）及纤维蛋白原（FIB）含量。结果透析后齿龈出血肝素钙组明显多于法安明组和速避凝组；两种低分子肝素组压迫止血时间明显短于肝素钙组（P均<0.05）；速避凝组体外循环系统血栓形成率最高，与肝素钙组比较P<0.05；但3种肝素使透析器容量下降率及对KT/V值的影响无显著差异。在血液透析过程中，法安明组及速避凝组PT无变化，PA增加，APTT、TT延长，FIB升高；肝素组透析30分钟即出现PT、APTT、TT显著延长，PA降低及FIB升高，并延续至透析结束。结论低分子肝素作为血液透析抗凝剂可起到与肝素钙同样的抗凝效果，同时减少出血倾向。使用速避凝抗凝时，至少应用0.4ml，才可达到理想抗凝效果。

Comparison study of two kinds of low molecular weight heparin and unfractionated heparin on anticoagulation during hemodialysis

Objective:To investigate the efficiency of standard heparin and two kinds of low molecular weight heparin (Frogmin and Fraxiparine) in hemodialysis.Methods:Thirtynine hemodialysis patients were randomized into unfractionated heparin (UFH),Frogmin and Fraxiparine groups.Results:No major bleeding was observed in all three groups,but significantly lower gum bleeding rate and shortened pressure time at the puncture sites were found in Fragmin amd Fraxiparine groups(all P<0.05).There was significantly higher incidence of thrombus formation in dialyzer than that with UFH,when Fraxiparine was used,but there was no decrease in dialyzed total blood compartment volumes in three groups.There was no difference of KT/V in three groups.However,significant longer prothrombin times(PT),activated partial thromboplastin time(APTT),thrombin time(TT) and decreased prothrombin activity(PA) were observed in UFH group(all P<0.05).There was no significant change in PT and significant increase of PA during hemodialysis in Frogmin and Fraxiparine groups.Conclusions:LMWH provides an effective and safe anticoagulation effect in hemodialysis patients.