比较低分子肝素两种静脉给药方式在连续性肾脏替代治疗中的应用

›› 2010, Vol. 9 ›› Issue (3): 143-146.

比较低分子肝素两种静脉给药方式在连续性肾脏替代治疗中的应用

王磊杜慧明孙悦郝丽丽王晶晶陈楠樊晓智王梅

北京大学人民医院肾内科

收稿日期:2010-01-29 修回日期:1900-01-01 出版日期:2010-03-12 发布日期:2010-03-12

Comparison of the two intravenous methods for low molecular weight heparin administration in continuous renal replacement therap

WANG Lei, DU Hui-ming, SUN Yue, HAO Li-li, WANG Jin-gjing, CHEN Nan, FAN Xiao-zhi, WANG Mei

Department of Nephrology, Peking University People’s Hospital, Beijing 100044, China

Received:2010-01-29 Revised:1900-01-01 Online:2010-03-12 Published:2010-03-12

摘要/Abstract

摘要：

【摘要】目的比较低分子肝素两种静脉给药方式在连续性肾脏替代治疗(continuous renal replacement therapy，CRRT)中的抗凝效果及安全性。方法选择重症急性肾衰竭伴或不伴多器官功能衰竭需行CRRT治疗应用法安明抗凝的患者，按照给药方式不同分为A组(间断静脉给药)和B组(持续静脉给药0，进行自身交叉对照，A组：首次剂量30～40 IU/kg，每4 h给药一次，每次剂量依次递减10%。B组：首次剂量15～25 IU/kg, 维持量5～10 IU/(kg·h)；治疗结束前1 h停药；生色底物法测定抗Xa因子活性，检测治疗前后凝血功能、血肌酐和尿素氮等指标。结果 17例连续性静静脉血液滤过治疗(continuous veno-venous hemofiltration，CVVH)患者入选，A组和B组的法安明总剂量分别为(8117.65±788.38)IU和(7976.47±898.28)IU，差异无统计学意义(t =0.597，P＞0.05)，实际治疗时间分别为(11.72±0.53)h和(11.82±0.50)h，差异无统计学意义(t=0.549，P＞0.05)。两组各有1例临床显性出血，治疗前后血肌酐和尿素氮下降率差异均无统计学意义(均P＞0.05)。两组抗Xa因子活性均在CVVH治疗2 h达到高峰，其中A组抗Xa因子水平显著高于B组[(0.65±0.17)IU/ml vs (0.51±0.15)IU/ml，t =3.730，P＜0.05]，其他时间点差异均无统计学意义(均P＞0.05)。两组治疗结束时活化部分凝血活酶原时间(activated partial thromboplastin time，APTT)均较治疗前延长[A组：(38.79±6.26) vs (33.54±9.12)，t=2.270，P＜0.05；B组：(36.24±5.21) vs (32.36±6.22)，t = 2.370，P＜0.05]。结论法安明无论采用间断静脉给药还是采用持续静脉给药均可安全有效地应用于CVVH治疗，持续静脉给药方式能够保持抗Xa因子水平相对稳定，间断静脉给药方式可能导致患者凝血功能较大波动。

关键词: 连续性肾脏替代治疗, 连续性静静脉血液滤过, 低分子肝素, 抗凝, 给药方式, 抗Xa因子

Abstract:

【Abstract】 Objective To compare the anticoagulation safety and efficacy of the two intravenous methods for low molecular weight heparin administration in continuous renal replacement therapy (CRRT). Methods Seventeen patients with severe acute renal failure with or without multiple organ failure and undergoing CRRT using Fragmin for anticoagulation were enrolled in this study. They were assigned to 2 groups: group A using continuous administration of Dalteparin/Fragmin, and group B using intermittent administration of Dalteparin/Fragmin. Anti-Xa factor activity, coagulation indexes, serum creatinine, and blood urea nitrogen were measured before and after CRRT. Results Anti-Xa factor activity was significantly higher in group A than in group B after continuous veno-venous hemofiltration (CVVH) for 2 hours, but did not differ between the 2 groups at other time points. Activated partial thromboplastin time (APTT) was significantly increased at the end of CVVH in both groups. Conclusion Either continuous or intermittent administration of Dalteparin/Fragmin is safe and effective, but intermittent administration may cause greater variation in anticoagulation status.

Key words: Continuous veno-venous hemofiltration, Low molecular weight heparin, Anticoagulation, Anti-Xa factor

王磊杜慧明孙悦郝丽丽王晶晶陈楠樊晓智王梅. 比较低分子肝素两种静脉给药方式在连续性肾脏替代治疗中的应用[J]. , 2010, 9(3): 143-146.

WANG Lei;DU Hui-ming;SUN Yue;HAO Li-li;WANG Jin-gjing;CHEN Nan;FAN Xiao-zhi;WANG Mei. Comparison of the two intravenous methods for low molecular weight heparin administration in continuous renal replacement therap[J]. , 2010, 9(3): 143-146.