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目的探讨多器官功能障碍综合症(MODS)患者在低分子量肝素抗凝治疗过程中凝血因子Ⅹ和凝血参数监测的意义。方法采用ACL200血凝仪连续监测(0,1h,24h,48h,96h)MODS患者血浆凝血因子Ⅹ活性、凝血酶原时间(PT)、部分凝血活酶时间(APTT)的变化,分别将使用低分子量肝素抗凝后1h,24h,48h,96h血浆凝血因子Ⅹ活性、PT、APTT与用药前比较。结果使用低分子量肝素抗凝治疗后1h,PT、APTT均延长,凝血因子Ⅹ活性明显下降;低分子量肝素维持量(第24h,48h,96h)时,凝血因子Ⅹ活性各测定值之间无显著性差异(P>0.05),但与用药前比较,具有非常显著性差异(P<0.01),而PT、APTT与用药前比较无显著性差异。结论在低分子量肝素抗凝治疗过程中,监测凝血因子Ⅹ和凝血参数非常必要,且监测凝血因子Ⅹ较监测PT、APTT更为有用。检测血浆凝血因子Ⅹ活性是监测MODS患者低分子量肝素抗凝治疗过程中十分有用的方法。
Objective To investigate the significance of coagulation factor Ⅹ and coagulation parameters monitoring in patients with multiple organ dysfunction syndrome (MODS) during low molecular weight heparin anticoagulation therapy. Methods The blood coagulation factor Ⅹ activity, prothrombin time (PT) and partial thromboplastin time (APTT) in MODS patients were continuously monitored by ACL200 coagulation analyzer (0,1h, 24h, 48h, 96h) The molecular weight of heparin anticoagulant 1h, 24h, 48h, 96h plasma coagulation factor Ⅹ activity, PT, APTT compared with before treatment. Results After 1 h of low molecular weight heparin anticoagulation therapy, the PT and APTT were prolonged and the activity of coagulation factor Ⅹ decreased obviously. There was no significant difference between the two groups in the maintenance of low molecular weight heparin (24h, 48h, 96h) (P> 0.05), but there was a significant difference (P <0.01) compared with that before treatment, but there was no significant difference between PT and APTT before treatment. Conclusion In the course of low molecular weight heparin anticoagulant therapy, it is necessary to monitor coagulation factor Ⅹ and coagulation parameters, and it is more useful to monitor coagulation factor Ⅹ than to monitor PT and APTT. Detection of plasma clotting factor Ⅹ activity is a very useful method for monitoring low molecular weight heparin anticoagulation therapy in patients with MODS.