改良式无肝素抗凝在高危出血倾向患者连续性血液滤过中的应用

目的探讨改良式无肝素抗凝在高危出血倾向患者连续性静脉-静脉血液滤过(CVVH)应用中的可行性和安全性。方法采用自身对照法将36例具有高危出血倾向行无肝素CVVH治疗的患者按治疗单、双日分为观察组、对照组。对照组采用传统无肝素抗凝治疗64例次,观察组采用改良式无肝素抗凝治疗64例次。比较两组患者治疗前后临床指标变化、体外循环凝血及治疗后出血并发症情况。结果治疗前、后两组Hb、PT、APTT组内比较,差异无统计学意义(均P>0.05),而PLT和Fbg治疗前后比较,差异有统计学意义(均P<0.05)。两组间Hb、PT、APTT、PLT、Fbg比较,差异无统计学意义(均P>0.05)。两组滤器和静脉壶凝血情况比较,差异有统计学意义(均P<0.01)。两组无一例诱发或加重出血。结论对高危出血倾向患者行改良式无肝素CVVH治疗能起到安全有效的抗凝效果,还可降低滤器和静脉壶凝血发生率。

Application of modified heparin-free anticoagulation to patients at high risk of hemorrhage and receiving continuous venovenous hemofiltration

Objective To explore the feasibility and safety of modified heparin-free anticoagulation applied to patients at high risk of hemorrhage and receiving continuous venovenous hemofiltration(CVVH). Methods Thirty-six participants at high risk of hemorrhage and receiving CVVH were enrolled in this self-control study,and they were treated with traditional heparin-free anticoagulation on an odd date(control group) and with modified heparin-free anticoagulation on an even date(observation group).Both anticoagulation methods were studied for 64 times.Fluctuations of clinical parameters before and after treatment,extracorporeal coa-gulation and hemorrhage after treatment were compared. Results There were no statistical differences in Hb,PT and APTT before and after the treatment in both groups(P>0.05 for all),while PLT and Fbg had significant differences before and after the treatment in both groups(P<0.05 for both).The above-mentioned parameters showed no statistical differences between the two groups(P>0.05 for all).The occurrence rates of clots formed in the filter and venous chamber had significant differences between the two groups(P<0.01 for both).None of both groups developed bleeding. Conclusion Modified heparin-free anticoagulation is a safe and effective method for patients at high risk of hemorrhage and receiving CVVH,and it can reduce clots formed in the filter and venous chamber.