关键词: 低血小板症, 多脏器功能障碍综合征, 连续性静静脉血液滤过, 抗凝

Abstract: Objective To investigate the effect of different anticoagulant methods in continuous venous-venous hemofiltration (CVVH) in critical patients with multiple organ dysfunction syndrome (MODS) and thrombocytopenia. Methods Fifty-four Person-times CVVH in 12 patients with MODS and thrombocytopenia were divided into four groups: low dose heparin group (LDH), low molecular weight heparin group (LMWH), no heparin group(NH), minor dose low molecular weight heparin and normal saline washing group (COM). Anticoagulant effect, bleeding and platelet were detected in each group within the first 12 hours CVVH. Results Blood coagulation in the extracorporeal circuit was more serious in NH than in other groups. Bleeding was more obvious in LDH and LMWH group in early time, while in NH gorup bleeding was more obvious in late time, no change in COM group, but bleeding were less in COM patients compared with other group. After CVVH, Prothrombin activity(Pa) was improved significantly in each group, active partial thromboplastin time(APTT), prothrombin time(PT) and thromboplastin time(TT) were normalized gradually in each group except LDH group. Comparing to the other three groups, platelets in NH group were reduced significantly,and the creatinine did not decrease obviously after 12h CVVH. Conclusion Anticoagulation with minor dose low molecular weight heparin and normal saline washing for the CVVH to the severe patients with MODS and thrombocytopenia was more effective, less bleeding and less impact on platelet. 

Key words: MODS, CVVH, Anticoagulant methods