达肝素钠在肾功能衰竭伴有出血病人血液透析中的应用

目的：观察达肝素钠在肾功能衰竭伴有出血病人血液透析（ 血透） 中抗凝的剂量、疗效和安全性。方法：试验分２ 个阶段。第１ 阶段３７ 例病人（ 男性２３ 例，女性１４ 例；年龄５１ ａ ±ｓ ７ ａ） 分别采用无肝素与达肝素钠（４０ Ｉ Ｕ／ｋｇ ，ｉｖ） 血透各３ 次。第２ 阶段该３７ 例病人分为３ 组，肝素组１２ 例，达肝素钠５０ Ｉ Ｕ／ｋｇ ，ｉｖ 组１２ 例和６０ Ｉ Ｕ／ｋｇ ，ｉｖ 组１３ 例，每例各行血透９ 次。结果：体外循环凝血率达肝素钠４０ Ｉ Ｕ／ｋｇ 组明显低于无肝素组（ Ｐ＜ ０ ．０１） ， 但高于６０ Ｉ Ｕ／ｋｇ 组（ Ｐ＜ ０ ．０５） 。达肝素钠组无出血发生，而肝素组有４ 例出血复发（ Ｐ＜ ０ ．０５） 。达肝素钠６０ Ｉ Ｕ ／ ｋｇ 组第５ 次血透２ ｈ Ｃｃｒ 高于肝素组（ Ｐ ＜０ ．０５） 。结论：达肝素钠５０ ～６０ Ｉ Ｕ／ｋｇ 于每次血透前用单剂量ｉｖ 安全、有效。

Use of dalteparin sodium on hemodialysis of renal failure patients with hemorrhage

AIM: Observing the efficacy, safety and suitable dosage of dalteparin sodium in the treatment of hemodialysis (HD) on the renal failure patients with hemorrhage. METHODS: The trial was divided into to two phases. The first phase had 37 patients (M 23, F 14; age 51 a±s 7 a), every patient was tested by both non_heparin and dalteparin sodium (40 IU/kg, iv) for three times. In the second phases, all the patients were divided into three groups: heparin group 12 patients, dalteparin sodium 50 IU/kg group 12 patients, dalteparin sodium 60 IU/kg group 13 patients. All the patients received HD for 9 times. RESULTS: The coagulation with dalteparin sodium 40 IU/kg group is significant less than non_heparin group (P<0.01), but greater than 60 IU/kg group (P<0.05). There isn't side effect of bleeding in dalteparin sodium group, but hemorrhage relapse happened on four patients in heparin group (P < 0.05). The Ccr of dalteparin sodium 60 IU/kg group was greater than heparin group at two hours in the fifth HD(P<0.05). CONCLUSION: Dalteparin sodium 50_60 IU/kg iv as a single dosage used before HD is safe and efficient.