改良无肝素吸附法在高危出血倾向患者血液透析中的应用

摘要

目的：探讨改良无肝素吸附法在高危出血倾向患者血液透析（ HD）中的应用。方法：将69例维持性HD患者随机分为观察组37例和对照组32例，对照组采用传统无肝素生理盐水冲洗法，观察组采用改良式吸附法无肝素透析联合盐水冲洗法。比较两组凝血功能、生化指标、有效治疗时间、生理盐水冲洗量、超滤量情况、管路及透析器凝血程度、静脉端穿刺点压迫止血时间及新出血情况等。结果：两组凝血功能、生化指标、有效治疗时间、生理盐水冲洗量、超滤量情况比较差异均有统计学意义（P＜0．05）；观察组管路及透析器凝血等级以0级、Ⅰ级为主，占69．41％，对照组以Ⅱ级、Ⅲ级为主，占65．93％，两组比较差异有统计学意义（P＜0．05）；两组均未出现新出血灶，动脉端、静脉端止血时间与对照组比较差异无统计学意义（P＞0．05）。结论：改良式无肝素吸附法联合生理盐水冲洗不会影响高危出血倾向HD患者的凝血功能，但可以减少或减轻体外循环凝血程度，延长有效治疗时间，有利于溶质的清除，不会增加患者出血风险，安全可靠，值得推广应用。%Objective:To explore the application of the modified adsorption method in heparin-free dialysis to hemodialysis( HD) pa-tients with high-risk bleeding tendency.Methods:69 maintenance HD patients were randomly divided into the observation group(n=37) and the control group(n=32).The traditional saline flushes method was used in the control group and the modified adsorption method combined with saline flushes method was used in the observation group.The blood coagulation function,biochemical indicators,effective treatment time,saline flushing quantity,ultrafiltration volume,pipeline and dialyser coagulation,the time of hemostasis by compression on puncture point and the occurrence of new bleeding were compared between the two groups.Results:There were statistically significant differences in the comparison of the blood coagulation function,biochemical indicators,effective treatment time,saline flushing quantity and ultrafiltration volume between the two groups(P<0.05);the degree of pipeline and dialyzer coagulation was mainly in level 0 and level I in the observation group,accounting for 69.41%;in level II and III in the control group,accounting for 65.93%( P<0.05);no new hem-orrhage in both groups,the comparison of hemostasis time at arterial and venous end was not significantly different between the two groups (P>0.05).Conclusion:The modified adsorption method combined with saline flushes method does not affect the coagulation function of HD patients high-risk bleeding tendency,but it can reduce or mitigate the coagulation degree during extracorporeal circulation,prolong the effective treatment time and is conducive to the removal of the solute.