慢性重型肝炎患者连续性血液净化治疗过程中肝素对凝血功能的影响

目的观察慢性重型肝炎患者在连续性血液净化治疗中使用肝素抗凝的临床安全性、监测指标变化。方法10例慢性重型肝炎患者连续性血液净化治疗72h，于治疗前、后定期观察患者的病情，检测全血活化部分凝血活酶时间（APTT）、凝血酶原活动度（PTA）、激活凝血酶原时间（ACT）、血常规等。结果患者耐受性良好，4例出现静脉置管处渗血。在治疗过程中PTA明显下降，治疗24～72h下降最为显著。治疗开始后APTT、ACT、PLT和HB均有所降低（P值分别为0．1102,0．3135、0．0728、0．1004）。结论慢性重型肝炎连续性血液净化治疗中使用肝素抗凝安全有效，但必须结合APTT、ACT、PTA和患者情况综合决定肝素用量。治疗过程中未发生严重出血、过敏等不良反应。

Effects of heparin on blood coagulation function in patients with chronic severe hepatitis during continuous blood purification treatment

Objective To investigate the safety of the heparin to avoid blood coagulation in patients with chronic severe hepatitis during continuous blood purification treatment, observe the indices. Method Ten patients with chronic severe hepatitis received continuous blood purification treatment for 72 hours. Patient's signs and symptoms, APTT, PTA, ACT, and blood routine test were recorded before and during the treatment. Results All the patients had a good tolerance. Errhysis from vein in-dwelling catheter was observed in 4 patients. PTA decreased significantly, especially during 24~72 hours of the treatment (P<0.05). APTT, ACT, PLT and HB also decreased (P=0.110 2, 0.313 5, 0.072 8, 0.100 4, respectively). Conclusions Heparin is effective and safe to avoid blood coagulation in patients with chronic severe hepatitis during continuous blood purification treatment. But the dose of heparin necessarily depends on APTT, ACT, PTA and the signs and symptoms of the patients. During the treatment, there are no severe compli-cations such as hemorrhage and allergic reaction.