摘要:
Objective To understand the effect of heparin saline for catheter locking after heparin-free dialysis on patients with bleeding risk by comparison of coagulation parameters before and after heparin-free dialysis and after heparin saline filling in catheter for 30 minutes with the baseline data in non-dialysis days. Methods A total of 26 patients were treated with heparin-free dialysis in our department from June to September, 2011. Their catheters were fully filled with 1:1 heparin saline (3,125U/ml)accordingto the volume marked on them. The coagulation parameters in non-dialysis days were recorded as the baseline data, and blood samples were taken at the time points of 5 minutes after starting dialysis, after dialysis but before catheter locking, and 30 minutes after catheter-locking. Results Activated partial thromboplastin time (APTT) at the 4 time points mentioned above were 28.75 (26.60-31.63), 32.65 (28.30-54.03), 28.25 (26.53-32.03), and 47.90 (35.80-199.65) seconds, respectively. There were no differences between the data after dialysis but before catheter locking and at baseline condition. However, the values after starting dialysis for 5 minutes and after filling the catheter with heparin saline for 30 minutes were longer than the baseline value (P=0.0003 and 0.0001, respectively), and their median values were also longer than the baseline value by 13.6% and 66.7%, respectively. After filling the catheters with heparin saline, other parameters including prothrombin time (PT) and international normalized ratio (INR) were longer than the values before heparin saline filling the catheters (P=0.000). Conclusion The effect of routine heparin-free dialysis on coagulation parameters is trivial. However, 1:1 heparin saline for locking the catheters leads to a significant increase of APTT beginning from starting dialysis to a certain period of time after dialysis. Therefore, heparin saline used for locking catheters may increase bleeding potentials in patients with higher bleeding risk.%目的 通过自身对照比较无肝素透析前、后和封管后30min凝血指标与非透析日基线值的差异,了解高危出血患者无肝素透析后肝素盐水封管对出血风险的影响. 方法 解放军总医院第一附属医院肾内科2011年6~9月间无肝素透析的患者共26例,透析后使用1∶1肝素盐水(3125U/ml)按照导管标记容积封管.事先记录非透析日的血凝指标作为基线值,并于透析开始5min、透析后(封管前),封管后30min分别采血检测血凝指标. 结果 该组患者在上述4个时间点的部分凝血活酶时间(APTT)分别为28.75 (26.60~31.63)、32.65(28.30~54.03)、28.25(26.53~32.03)、47.90 (35.80~199.65),其中透析后(封管前)数据较基线值无差异,但透析开始后5min、封管后30min的数据较基线值明显延长(P=0.0003,0.0001),其中位数比较基线值分别延长达13.6%和66.7%.其他指标如凝血酶原时间(PT)、国际标准化比值(INR),在封管后较封管前也都有明显延长(P≤0.0001). 结论 常规的无肝素透析对凝血各指标影响不明显,但1∶1肝素盐水封管将造成透析开始后短时间内和透析后一定时段内APTT的明显延长,因此,目前采用的肝素盐水封管方式很可能增加出血风险.