中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (06): 371-374.doi: 10.3969/j.issn.1671-4091.2015.06.013

• 血管通路 • 上一篇    下一篇

不同浓度肝素封管液对常规凝血功能和血栓弹力图的影响

杨松涛,刘占肖,张庆娴,王小芹,肖跃飞   

  1. 航天中心医院肾内科
  • 收稿日期:2014-11-14 修回日期:2015-03-25 出版日期:2015-06-12 发布日期:2015-05-29
  • 通讯作者: 肖跃飞 xyf01_2012@163.com E-mail:liuzhanxiao@sina.com

The effect of heparin concentration for catheter lock on conventional coagulation functions and thromboelastograph

  • Received:2014-11-14 Revised:2015-03-25 Online:2015-06-12 Published:2015-05-29

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摘要： 【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。

关键词: 肝素, 封管, 血栓弹力图

Abstract: 【Abstract】Objective To investigate the effect of heparin concentration for catheter lock on conventional coagulation functions and thromboelastograph (TEG). Methods Fifty patients treated with continuous renal replacement therapy (CRRT) using local citrate anticoagulation were randomly divided into two groups according 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). ②There 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. ③There 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 analyze the cause of bleeding and to guide protamine therapy in case of coagulation dysfunction.

Key words: Heparin, Catheter Lock, Thromboelastograph