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目的探讨无肝素血液透析体外循环凝血的危险因素,为临床合理干预措施提供理论参考。方法收集2013年7月至2015年10月我院收治的120例行血液透析治疗患者为研究对象,依据患者有无肝素血液透析分为肝素组(67例)及无肝素组(53例),并以同期于我院体检60例健康志愿者为健康组,观察3组凝血功能指标[活化部分凝血活酶时间(a PTT)、纤维蛋白原(Fbg)、血浆凝血酶时间(TT)]、血液相关指标[血红蛋白(Hb)、血小板计数(PLT)、红细胞压积(PCV)],采用单、多因素分析无肝素血液透析体外循环凝血的危险因素。结果肝素组a PTT、Fbg、TT最高,无肝素组次之,健康组最低,3组之间两两相较有统计学意义(P<0.05);三组Hb、PLT、PCV相较无明显差异(P>0.05);单、多因素分析显示,高Hb、PLT、血流不佳、合并恶性肿瘤为无肝素血液透析体外循环凝血的独立危险因素(P<0.05)。结论无肝素血液透析治疗患者存在体外循环凝血风险,影响体外循环凝血的高危因素较多,临床可据此展开合理有效的干预措施。
Objective To investigate the risk factors of extrahepatic coagulation without hemodialysis hemodialysis to provide theoretical reference for clinical reasonable interventions. Methods A total of 120 hemodialysis patients admitted to our hospital from July 2013 to October 2015 were enrolled in this study. Patients were divided into heparin group (n = 67) and non-heparin group (n = 53) In the same period, 60 healthy volunteers in our hospital were selected as healthy group. The indexes of coagulation function (a PTT, fibrinogen, thrombin time) were observed, Hemoglobin (Hb), platelet count (PLT) and hematocrit (PCV) were used to analyze the risk factors of coagulation after cardiopulmonary bypass without heparin. Results The heparin group had the highest PTT, Fbg and TT, followed by the non-heparin group, and the lowest in the healthy group (P <0.05). There was no significant difference between the three groups in Hb, PLT and PCV (P> 0.05). Univariate and multivariate analysis showed that high Hb, PLT, poor blood flow and malignant tumor were independent risk factors for extrahepatic coagulation after heparin-free hemodialysis (P <0.05). Conclusion There is a high risk of extracorporeal coagulation in patients undergoing heparin-free hemodialysis and high risk factors for extracorporeal coagulation. Therefore, reasonable and effective interventions should be carried out in clinical practice.