低分子肝素和小剂量肝素在高危出血倾向患者血液透析中的疗效比较.doc

1 低分子肝素和小剂量肝素在高危出血倾向患者血液透析中的疗效比较论文联盟。作者:李钊伦,王瑜, 梁璇,薛武军,田普训【关键词】低分子量肝素;血液透析;出血/ 预防和控制【 Abstract 】 AIM: pare the effect of lowmolecular wEight heparin with that of lowdose heparin on hemodialysis patients at high risk of bleeding. METHODS: Seventysix patients at high risk of bleeding were administered with lowmolecular wEIght heparin or lowdose heparin before hemodialysis. The pressing time after puncturation in the arteriovenous fistulae, different coagulation parameters and blood coagulation in the dialyzer were evaluated in the 2 groups. The changes of pro and posthemodialysis in platelet counting, thrombin time (TT) and activated partial thromboplastin time (APTT) were investigated. RESULTS: The pressing time after puncturation in the arteriovenous fistulae, the posthemodialysis blood coagulation in the dialyzer and the cessation of bleeding 2 in the skin and mucosa were similar in the 2 groups. The cessation time of occult bleeding was shorter in lowmolecular weight heparin group than that of lowdose heparin group after hemodialysis (). Compared with prohemodialysis, platelet counting was decreased, TT and APTT were slightly prolonged after hemodialysis () in each group, and APTT was prolonged more obviously in lowdose heparin group (). The posthemodialysis coagulation parameters in the lowmolecular weight heparin group were prior to that of the lowdose heparin group (), but platelet counting was not. CONCLUSION: Application of lowmolecular weight heparin is safer than that of lowdose heparin in hemodialysis patients at high risk of bleeding. 【 Keywords 】 lowmolecular weight heparin; hemodialysis; hemorrhage/prevention and control 【摘要】目的:比较小剂量肝素和低分子肝素在高危出血倾向患者血液透析中的应用及优劣. 方法: 比较 76例高危出血倾向血液透析患者在透析前用小剂量肝素和低分子肝素处理后动静脉瘘穿刺点压迫所需时间、透析后透析器及管路凝血情况. 并比较透析前后血小板计数、凝血酶时间 3 (TT) 、部分凝血活酶时间(APTT) 变化. 结果:低分子肝素组与小剂量肝素组相比, 透析后穿刺点平均所需压迫时间、透析器及管路凝血情况以及皮肤黏膜出血停止时间无差异, 但潜血转阴时间较小剂量肝素组短(). 两组透析前各项指标差异无统计学意义,透析后结果显示血小板计数下降、 TT 和 APTT 较透析前延长() ,其中小剂量肝素组的 APT T