不同肝素钠抗凝治疗方案在肝衰竭患者血浆置换中的比较研究

A comparative study of different anticoagulant regimens of heparin in plasma exchange for patients with liver failure

摘要:

目的 探讨肝衰竭患者血浆置换中安全有效的肝素钠抗凝治疗方案。方法 选取2018年1月—8月河南省人民医院感染性疾病科收治的肝衰竭行血浆置换患者114例为研究对象。根据不同抗凝治疗方案分为肝素钠全量组（A组），仅采用首次剂量肝素钠组（B组），以及不采用首次剂量、采用术中持续匀速泵入肝素钠组（C组）。比较3组患者血浆置换治疗前后的白细胞（WBC）、血小板（PLT）、肌酐、尿素、天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、总胆红素（TBIL）、白蛋白（Alb）、前白蛋白（PA）、D-二聚体、二氧化碳结合力（CO₂CP）、血红蛋白（Hb）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）及纤维蛋白原（FBG），以及血滤器及管道凝血情况。结果 3组患者WBC、PLT、肌酐、尿素、AST、ALT、TBIL、Alb、PA、D-二聚体、CO₂CP治疗前后的差值比较，差异无统计学意义（P >0.05）；3组患者的Hb、PT、APTT及FBG治疗前后的差值比较，差异有统计学意义（P <0.05）；3组患者血滤器凝血发生情况为：A组1级1例，发生率为2.5%；B组1级1例，2级1例，发生率为5.0%；C组2级2例，发生率为5.9%，3组比较，差异无统计学意义（P >0.05）。3组患者均未发生管道凝血。结论 血浆置换中不采用首次剂量、持续匀速泵入小剂量肝素钠、治疗结束前30 min停止使用的抗凝方案，对肝衰竭患者凝血情况的发生及凝血功能的影响最小，且不影响患者治疗效果。

Abstract:

Objective To explore the safe and effective anticoagulant regimens of heparin in plasma exchange (PE) for hepatic failure patients.Methods From January 2018 to August 2018, 114 hepatic failure patients receiving PE in our hospital were treated as the objects of study and randomly divided into three groups according to the different heparin administration schemes, including full dose heparin group (group A), initial dose administration group (group B), and intraoperative administration without an initial dose group (group C).Results There was no significant differences in liver functions and kidney functions between the three groups after treatment (P > 0.05). Additionally, there was significant difference in hemoglobin and coagulation function after treatment (P < 0.05). The coagulation functions in three groups were improved after treatment. The intraoperative continuous administration without an initial dose scheme had attained the best effect (P < 0.05).Conclusions Intraoperative heparin administration at a constant velocity without an initial dose during PE makes no difference to the therapeutic effect; in addition, it can reduce the influence of heparin on coagulation function, and reduce the occurrence of coagulation during the operation.