中国血液净化

›› 2004, Vol. 3 ›› Issue (9): 493-495.

• 人工肝 • 上一篇    下一篇

监测APTT指导重型肝炎患者人工肝治疗的肝素用量 

陈 煜 段钟平 刘义荣 韩大康 赵 军 于 莹   

  1. 100054 北京，首都医科大学附属北京佑安医院人工肝中心
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2004-09-12 发布日期:2004-09-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2004-09-12 Published:2004-09-12

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摘要：

目的 通过血凝仪监测APTT变化探讨重型肝炎患者人工肝治疗时肝素的最佳用量。方法 应 用半自动血凝仪检测活化部分凝血活酶时间（APTT），对比肾透析和重型肝炎患者肝素应用后APTT的变化情况及重型肝炎患者应用不同剂量肝素后APTT的变化情况，并通过实时监测人工肝治疗时患者APTT的变化状况随时调整肝素的用量。观察管路有无凝血，皮肤黏膜、穿刺或置管部位有无渗血或出血。结果 重型肝炎组应用肝素后APTT变化值明显大于肾透析组，统计学有显著性差异。大剂量肝素组重型肝炎患者肝素应用后5分钟有90.5%的患者APTT大于100秒，30分钟后仍有47.6%的患者APTT大于100秒，均显著高于小剂量肝素组。APTT比正常对照值延长40%～80%的情况下，既没有发生管路凝血，也没有加重出血倾向。结论 重型肝炎患者肝素应用后凝血机制的变化更加明显，相对于肾透析而言应显著减少肝素用量。实时监测APTT的变化使之比正常对照值延长40%～80%，既可防止管路凝血又可降低出血的风险。

关键词: 人工肝, 治疗, 肝素, 剂量

Abstract: Objective To obtain an optimal therapeutic dosage of heparin in gravis hepatitis patients with the treatment of artificial liver. Methods Comparing the change of APTT between gravis hepatitis patients and dialysis patients, and that in gravis hepatitis patients using different dosage of heparin. Real time Monitoring of APTT was adopted to adjust the dosage of heparin. Blood clots in the pipeline and bleeding in the skin and punctured site were observed. Results The change of APTT after applying heparin was much greater in gravis hepatitis patients than that in dialysis patients. Blood clots in the pipeline were found in two patients in low-dosage heparin group without interfering the treatment. One patient had bleeding in the puncture site in the high-dosage heparin group. Five minutes and 30 minutes after applying heparin in the high-dosage heparin group, the ratio of prolonged APTT above 100s was 90.5% and 47.6% respectively, and higher than that in the low-dosage heparin group. Neither coagulation nor bleeding was occurred in the condition which APTT was prolonged up to 40%～80% compared with the normal value. Conclusion The change of coagulation function after applying heparin is more obvious in gravis hepatitis patients. The required dosage of heparin for anti-coagulation is relatively less in gravis hepatitis patients compared with dialysis patients. APTT is prolonged up to 40%-80% compared with the normal value which can not only prevent coagulation in the pipeline but also decrease the risk of bleeding.

Key words: Therapy, Heparin, Dosage

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