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目的:探讨血液透析患者在透析中肝素抗凝剂的应用情况。方法:比较高危出血倾向血液透析患者在透析前用小剂量肝素(小剂量肝素组)和低分子肝素钙(低分子肝素钙组)处理后动静脉瘘穿刺点压迫所需时间、透析后透析器及管路凝血情况,并比较透析前后血小板计数、治疗前后血尿素氮(BUN)和血肌酐(Scr)变化以及部分凝血活酶时间(APTT)的变化。结果:低分子量肝素钙组透析后穿刺点平均所需压迫时间明显短于小剂量肝素组(P<0.05);透析过程中静脉压无明显升高,但两组在透析器和透析管路的凝血程度上比较差异有显著性(P<0.01);皮肤黏膜出血停止时间差异无统计学意义(P>0.05),但潜血转阴时间较小剂量肝素组短(P<0.05)。两组尿素氮和肌酐下水平无明显差异;透析后结果显示血小板计数下降,两组APTT较透析前均延长,差异无统计学意义(P>0.05)。结论:低分子肝素钙较小剂量肝素用于有出血倾向患者的血液透析更具安全性。
Objective: To investigate the application of heparin anticoagulants in hemodialysis patients during dialysis. Methods: To compare the time required for hemodialysis patients to heal arteriovenous fistula puncture after hemodialysis with low-dose heparin (low dose heparin group) and low molecular weight heparin calcium (low molecular heparin calcium group) before dialysis, dialyzer dialyzer And blood coagulation of the blood vessels. The changes of blood urea nitrogen (BUN) and serum creatinine (Scr) and partial thromboplastin time (APTT) were compared before and after dialysis. Results: The mean time needed for compression in the low-molecular-weight heparin group was significantly shorter than that in the low-dose heparin group (P <0.05); no significant increase in venous pressure was observed during dialysis, but dialysis and dialysis There was no significant difference in clotting degree (P <0.01). There was no significant difference in the stopping time of skin mucous membrane bleeding (P> 0.05), but the occult blood turning time was shorter than that in the low dose heparin group (P <0.05). No significant difference was found between the levels of urea nitrogen and creatinine in the two groups. The results of dialysis showed that the platelet count decreased. Both groups had longer APTT than before dialysis. The difference was not statistically significant (P> 0.05). CONCLUSION: Low molecular weight heparin is more safe for hemodialysis in patients with hemorrhagic tendency than lower dose heparin.