高出血风险MODS患者连续性血液滤过治疗抗凝方案的安全性及有效性分析

摘要

目的：探讨高出血风险多器官功能障碍综合征（MODS）患者连续性静脉静脉血液滤过（CVVH）抗凝方案的安全性及有效性分析。方法选择高出血风险MODS行CVVH治疗的患者40例，分为无肝素抗凝组（A组）和小剂量肝素抗凝组(B组)，观察2组治疗前、治疗后24 h、48 h ApacheⅡ评分、血小板计数、凝血功能、尿素氮、肌酐、氧合指数（PaO2/FIO2）的变化，并记录2组患者滤器寿命、机械通气时间、住重症监护病房（ICU）时间及出血并发症的发生情况。结果 B组治疗后24 h、48 h血肌酐、PaO2/FIO2、ApacheⅡ评分及尿素氮水平均较A组明显好转（均P<0.05）。B组治疗后24 h激活部分凝血活酶时间（APTT）、凝血酶时间（TT）均较治疗前明显延长，血小板计数明显下降，但随着治疗时间的延长，APTT、TT及血小板计数无明显变化。B组患者的平均机械通气时间、住ICU时间均较A组患者明显缩短，滤器使用寿命较A组明显延长（均P<0.05）。B组患者出现1例皮肤黏膜出血现象，无严重出血并发症发生。结论高出血风险MODS患者采用小剂量肝素抗凝可以保证CVVH治疗的顺利进行，临床应用安全、有效。%Objective To investigate safety and efficiency of anti-coagulation therapy in patients with high-risk of bleeding and multiple organ dysfunction syndrome (MODS) during continuous veno-venous hemofiltration (CVVH). Meth-ods Forty patients with high-risk bleeding MODS during CVVH in our hospital were divided into heparin-free group (A group) and low-dose heparin group (B group). Blood coagulation function, platelets counts, blood urea nitrogen, serum creati-nine, PaO2/FIO2 and Apache Ⅱ scores in two groups were tracked before treatment and 24 h, 48 h after treatment. Filter lifespan, median ventilation time, ICU admission time and bleeding complications were observed. Results (1)There was significant difference in levels of blood urea nitrogen, serum creatinine, PaO2/FIO2 and ApacheⅡscores at 24 h, 48 h after treatment between in low-dose heparin group and those in heparin-free group (P<0.05). (2)Levels of activated partial thromboplastin time(APTT), thrombin time (TT) were prolonged. Platelets count were significantly lower at 24 h after treat-ment than that before treatment in low-dose heparin group. Levels of APTT, TT and platelets count had no changes with pro-longed time of CVVH therapy.(3)Average ventilation time, ICU admission time were obviously shorter in low-dose heparin group than that in heparin-free group. Filter lifespan was significant longer in low-dose heparin group than that in heparin-free group, (P<0.05).(4)Bleeding in skin and mucosa was observed in 1 case in low-dose heparin group without other se-vere bleeding complications. Conclusion The results of monocentric study show that low dose of heparin ensure smooth op-eration of CVVH in patients with MODS and high-risk bleeding. The clinical application is safe and efficient.