维持性血液透析患者血液灌流凝血的危险因素分析

摘要

目的 了解维持性血液透析患者血液灌流凝血的发生情况,分析其危险因素.方法 对我院血液净化中心行血液灌流治疗的72例维持性血液透析患者进行回顾性研究,收集患者临床资料和生化指标,分析维持性血液透析患者血液灌流凝血的发生率及其危险因素.结果 72例维持性血液透析患者共进行血液灌流302例次,7例患者发生血液灌流凝血16例次,其中Ⅱ级凝血6例次,Ⅲ级凝血10例次.发生过血液灌流凝血的患者合并肿瘤、糖尿病、血管通路功能不良比例及血清低密度脂蛋白、脂蛋白a水平明显高于未发生过血液灌流凝血者,两组患者在年龄、性别、透析龄、超滤速度、机器温度、跨膜压、血肌酐、尿素氮、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、脂蛋白a、血红蛋白、血小板及透析前APTT活化部分凝血酶活酶时间等方面相比,差异无统计学意义(P＞0.05).凝血发生早期透析器呈现静脉压过低报警,凝血常发生在血液灌流1.5～2 h.结论 维持性血液透析患者常规行血液灌流治疗时存在凝血的风险.血液灌流联合血液透析过程中透析器呈现静脉压过低报警时应警惕凝血发生.合并肿瘤、糖尿病、血管功能不良比例及血清低密度脂蛋白、脂蛋白a水平增高的维持性血液透析患者联合血液灌流治疗时易发生凝血.%Objective To investigate the incidence, characteristic and risk factors of blood clotting during hemoperfusion plus hemodialysis in maintenance hemodialysis (MHD) patients. Methods From May 2008 to May 2009, a total of 72 cases of MHD patients in our blood purification center were enrolled in this retrospective study. The following data were collected: age, gender, dialysis duration, serum creatinine, lipid profile, etc. T test and x2 test were performed for statistics. Results 72 MHD patients performed 302 times of hemoperfusion. The prevalence of 0 ～Ⅰ, Ⅱ and Ⅲ-class blood clotting during hemoperfusion plus hemodialysis was 94.70%, 1.99% and 3.31%, respectively. Among 72 MHD patients, 7 patients suffered from blood clotting during hemoperfusion plus hemodialysis. The prevalence of malignant tumor, diabetes mellitus and blood vessel access dysfunction, as well as level of serum low density lipoprotein and lipoprotein a were significantly higher in MHD patients with blood clotting during hemoperfusion plus hemodialysis than in those without low density lipoprotein. There were no significant differences in terms of age, gender, dialysis duration,ultrafiltration velocity, dialysis machine temperature, transmembrane pressure, serum creatinine, urea nitrogen,triglyceride, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol,lipoprotein a, hemoglobin, platelet and activated partial thromboplastin time before dialysis between blood clotting and without blood clotting patients. The warning of low venous pressure appeared in the early stage of blood clotting during hemoperfusion plus hemodialysis. Blood clotting usually began during the last 30 minutes of hemoperfusion. Conclusions The prevalence of blood clotting during hemoperfusion plus hemodialysis in MHD patients was quite high. The warning of low venous pressure was a signal of blood clotting during hemoperfusion plus hemodialysis. Malignant tumor, diabetes mellitus, blood vessel access dysfunction, high serum low density lipoprotein cholesterol and lipoprotein a maybe be important risk factors of blood clotting during hemoperfusion plus hemodialysis in MHD patients.