摘要
目的探讨不同浓度肝素封管液对常规凝血功能和血栓弹力图(TEG)的影响。方法行局部枸橼酸抗凝的连续性肾脏替代治疗(CRRT)患者50例,根据肝素封管浓度不同随机分为两组:A组6250U/ml,B组3125U/ml。于CRRT前、CRRT后(封管前)及封管后30min检测血常规、凝血功能和TEG,封管30min后加作TEG肝素酶检测,记录24h内有无出血及血栓形成。结果 1血小板及常规凝血功能变化2组CRRT前后,血小板(PLT)及凝血酶原时间(PT)、部分凝血酶原时间(APTT)、凝血酶时间(TT)均无明显变化(P>0.05);封管后30min,2组PT、APTT及TT较封管前均延长(P<0.05),A组APTT及TT较B组明显延长(P<0.05)。3TEG R值变化2组CRRT前后TEG R值无明显变化(P>0.05),封管后30min R值均明显延长(P<0.05),A组延长较B组更明显(P<0.05)。A组有9例不凝血,B组有5例不凝血。经肝素酶中和后,2组R值均恢复正常。3不良事件发生情况2组均无血栓形成,A组出血事件多于B组(P<0.05)。其中7例出血明显者经监测TEG给予鱼精蛋白中和肝素,出血停止,R值恢复正常。结论 CRRT患者应用6250U/ml及3125U/ml肝素封管后处于高危出血状态。TEG检查可以用来指导判断CRRT患者出血原因,以及确定鱼精蛋白中和剂量。
Objective To investigate the effect of heparin concentration for catheter lock on convention- al coagulation functions and thromboelastograph （TEG）. Methods Fifty patients treated with continuous re- nal replacement therapy （CRRT） using local citrate anticoagulation were randomly divided into two groups ac- cording to lock heparin concentration： group A （6,250U/ml） and group B （3,125U/ml）. Blood routine tests, conventional coagulation tests and TEG were performed before CRRT, after CRRT and before catheter lock, and after catheter lock for 30 min. TEG disposable heparinase cups and pins were measured 30 min after lock. The incidences of bleeding and thrombosis in 24 hours were recorded. Results （1） There were no significant differences in PLT, prothrombin time （PT）, activated partial thromboplastin time （APTT） and thrombin time （TT） between before CRRT and after CRRT （P〉0.05）. PT, APTT and TT were significantly prolonged after lock for 30 min in both groups （P〈0.05）, and APTT and TT were longer in group A than in group B （P〈 0.05）. （2）There were no significant differences in TEG R values before CRRT and after CRRT in both groups （P〉0.05）. The R values were significantly extended after lock for 30 min in both groups, especially in group A （P〈0.05）. No blood clot was found in 9 cases in group A and 5 cases in group B. After neutralization with heparinase, the R values returned to normal in both groups. （3）There was no thrombosis in both groups, but bleeding episodes were found in both groups especially in group A （P〈0.05）. In 7 cases with remarkable bleeding, bleeding ceased after protamine treatment through monitoring TEG. Conclusions CRRT patients are at high risk of bleeding after catheter lock with 6,250U/ml or 3,125U/ml heparin. TEG can be used to ana- lyze the cause of bleeding and to guide protamine therapy in case of coagulation dysfunction.
出处
《中国血液净化》
2015年第6期371-374,共4页
Chinese Journal of Blood Purification
关键词
肝素
封管
血栓弹力图
Heparin
Catheter lock
Thromboelastograph
