不同抗凝药物对血液透析患者凝血指标变化及出血发生状况的影响
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摘要
目的探究血液透析患者使用不同抗凝药物治疗后凝血指标变化情况及出血发生状况。方法选取2017年6月—2018年6月于泰州市中西医结合医院肾内科行血液透析的80例患者,按照随机数字表法分为两组,每组40例。对照组在透析前给予静脉注射低分子肝素钙,观察组患者则给予依诺肝素钠;对比两组凝血指标变化、出血及凝血发生率。结果两组治疗前凝血各指标比较,差异无统计学意义(P>0.05);观察组血小板表面α颗粒膜蛋白(GMF-140)为(23.59±3.45)pmol/L、凝血酶原片段1+2(PF1+2)为(124.76±28.53)pmol/L、凝血速度(CR)为(18.42±3.26)sig/min、凝血时间(gbACT)为(162.53±20.14)s、血小板功能(PF)为(1.82±1.03),均低于对照组(28.74±3.61)pmol/L、(286.75±28.64)pmol/L、(23.58±3.72)sig/min、(178.92±23.48)s、(2.46±1.52),差异有统计学意义(t=6.523、25.343、6.598、3.351、2.205,P<0.05);观察组出血率为0.00%,凝血发生率为2.50%,均低于对照组15.00%、20.00%,差异有统计学意义(χ~2=4.505、4.507,P<0.05)。结论血液透析患者给予依诺肝素钠治疗有助于降低凝血指标,减少出血及凝血发生率,值得临床推广应用。
Objective To investigate the changes of coagulation parameters and the occurrence of hemorrhage in hemodialysis patients treated with different anticoagulant drugs. Methods 80 patients who underwent hemodialysis in the Department of Nephrology, Taizhou City Hospital of Integrated Traditional Chinese and Western Medicine from June 2017 to June 2018 were enrolled in the study. The patients were divided into two groups according to the random number table, 40 cases in each group. The control group was given intravenous low-molecular-weight heparin calcium before dialysis, and the observation group was given enoxaparin sodium; the coagulation index changes, bleeding and coagulation rate were compared between the two groups. Results There were no significant differences in the pre-treatment coagulation parameters between the two groups(P>0.05). The α-membrane protein(GMF-140) on the platelet surface of the observation group was(23.59±3.45)pmol/L, prothrombin fragment 1+ 2(PF1+2) was(124.76±28.53)pmol/L,coagulation rate(CR) was(18.42±3.26)sig/min, clotting time(gbACT) was(162.53±20.14) s, and platelet function(PF)was(1.82 ±1.03), both lower than the control group(28.74 ±3.61)pmol/L,(286.75 ±28.64)pmol/L,(23.58 ±3.72) sig/min,(178.92±23.48)s,(2.46±1.52), the difference was statistically significant(t=6.523, 25.343, 6.598, 3.351, 2.205, P<0.05);the bleeding rate of the observation group was 0.00%, and the coagulation rate was 2.50%, which was lower than the control group 15.00%, 20.00%, the difference Statistically significant(χ~2=4.505, 4.507, P<0.05). Conclusion Heparin sodium treatment in hemodialysis patients can help reduce blood coagulation index and reduce the incidence of bleeding and coagulation. It is worthy of clinical application.
Objective To investigate the changes of coagulation parameters and the occurrence of hemorrhage in hemodialysis patients treated with different anticoagulant drugs. Methods 80 patients who underwent hemodialysis in the Department of Nephrology, Taizhou City Hospital of Integrated Traditional Chinese and Western Medicine from June 2017 to June 2018 were enrolled in the study. The patients were divided into two groups according to the random number table, 40 cases in each group. The control group was given intravenous low-molecular-weight heparin calcium before dialysis, and the observation group was given enoxaparin sodium; the coagulation index changes, bleeding and coagulation rate were compared between the two groups. Results There were no significant differences in the pre-treatment coagulation parameters between the two groups(P>0.05). The α-membrane protein(GMF-140) on the platelet surface of the observation group was(23.59±3.45)pmol/L, prothrombin fragment 1+ 2(PF1+2) was(124.76±28.53)pmol/L,coagulation rate(CR) was(18.42±3.26)sig/min, clotting time(gbACT) was(162.53±20.14) s, and platelet function(PF)was(1.82 ±1.03), both lower than the control group(28.74 ±3.61)pmol/L,(286.75 ±28.64)pmol/L,(23.58 ±3.72) sig/min,(178.92±23.48)s,(2.46±1.52), the difference was statistically significant(t=6.523, 25.343, 6.598, 3.351, 2.205, P<0.05);the bleeding rate of the observation group was 0.00%, and the coagulation rate was 2.50%, which was lower than the control group 15.00%, 20.00%, the difference Statistically significant(χ~2=4.505, 4.507, P<0.05). Conclusion Heparin sodium treatment in hemodialysis patients can help reduce blood coagulation index and reduce the incidence of bleeding and coagulation. It is worthy of clinical application.
引文
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[9]桑艳芳.阿加曲班替代低相对分子质量肝素行抗凝治疗对床旁血液透析患者凝血功能、滤器使用寿命及出血性并发症的影响[J].血栓与止血学,2017,23(4):644-645.
[10]王彦江,谢席胜,冯胜刚.依诺肝素在血液透析抗凝治疗中的应用优势[J].西部医学,2018,30(2):231-233.
[2]张圣雨,宋惠珠,张秀红,等.血液透析患者以普通肝素抗凝致血小板减少的药学监护[J].医药导报,2018,37(4):489-491.
[3]张文强,石祖梅.维持性血透患者不同血管通路抗凝治疗及血栓并发症监测[J].医学临床研究,2018,35(4):700-702.
[4]赵筱娟,李红莉,安文军.血液透析过程中局部枸橼酸钠抗凝和普通肝素抗凝的临床随机对照研究[J].实用药物与临床,2018,21(3):279-282.
[5]王方利.维持性血液透析患者其Cuff导管应用不同抗凝剂的封存效果对比评价[J].国际泌尿系统杂志,2016,36(6):899-903.
[6]于海鹰,李松,毕桂玲.血液透析中局部枸橼酸与小剂量低分子肝素抗凝的联合应用分析[J].中国医药导刊,2016,18(6):618-620.
[7]刘扬,魏金凤,单福军,等.肝素与低分子量肝素对血液透析患者β2微球蛋白影响[J].中国中西医结合肾病杂志,2016,17(1):64-65.
[8]于续芳,黄占东.不同剂量的首剂肝素在维持性血液透析患者中的抗凝效果[J].临床肾脏病杂志,2016,16(5):299-302.
[9]桑艳芳.阿加曲班替代低相对分子质量肝素行抗凝治疗对床旁血液透析患者凝血功能、滤器使用寿命及出血性并发症的影响[J].血栓与止血学,2017,23(4):644-645.
[10]王彦江,谢席胜,冯胜刚.依诺肝素在血液透析抗凝治疗中的应用优势[J].西部医学,2018,30(2):231-233.