透析前注射单剂量低分子量肝素对透析器复用效率的评价

目的 评价血透前注射单剂量低分子量肝素（LMWH）与持续输注普通肝素（SH）对复用透析器效率的影响。方法 对30例慢性透析患者进行随机交叉对照研究，观察第1、4次透析的透析器纤维包裹容量（FBV）、透析前血球压积（HCT）及透析2h尿素氮、肌酐清除率；另外，利用生色底物法测定透析0h,2h,4h血浆肝素抗－Fxa水平。结果 同SH组比，LMWH组透析器复用次数增加（P＜0．05），第4次复用透析器FBV及透析2h尿素氮、肌酐清除率无下降（P＞0．05），SH组则下降（P＜0．05），透析2h两组血浆肝素活性－Fxa水平差异无显著性（P＞0．05），透析4hLWMH组高于SH组（P＜0．05）。结论 透析前单剂量注射LMWH能有效地保护复用透析器清除率，值得临床上进一步推广。

Evaluation on efficiency of low molecular weight heparin as a single bolus dose with reused dialyzers

Objective To evaluate the efficiency of low molecular weight heparin(LMWH, fraxiparine) given as a single predialysis bolus injection with reused dialyzers in comparison with standard heparin(SH) administered with a continuous infusion. Methods 30 hemodialysis patients were studied in a radomized crossover fashion. Dialyzers fibrer bundle volumes(FBV), predialysis hemocrit and 2 h clearance of urea, creatinine were observed in the first, the fourth dialysis. The plasma heparin activities(anti Fxa levels) were measured by the chromogenic substrate assay in 0 h, 2 h, 4 h of dialysis. Results Significant increase ( P< 0 05) was seen in the number of dialyzer reuse in LMWH group compared with SH group; there was not significant decrease in dialysis FBV as well as 2 h clearance of urea, creatinine ( P> 0 05); in addition, the plasma heparin activity(anti Fxa levels) were comparable in both groups after 2 h of dialysis, however, they were significantly higher after 4 h in the LMWH than those in the SH group ( P< 0 05). Conclusion LMWH as a single bolus dose can prevent decrease in dialyzer clearance. It is clinically worthy of further popularity.