Sun Xue-feng, Xiao Qing, Wang Yu, Hao Li-rong, Lin Hong-li, Zhang Zhi-min, Li Ji-jun, Chen Xiang-mei
Institute of Nephrology, General Hospital of Chinese People's Liberation Army, Beijing 100853, China.
Zhonghua Yi Xue Za Zhi. 2009 Mar 10;89(9):577-81.
To investigate the anticoagulant methods and characters of hemodialysis patients in hospitals of Grade III Level A.
A questionnaire survey was conducted in 7 hemodialysis centers of class 3 first level general hospital in Beijing, Shenyang, Harbin, and Dalian, on the hemodialysis status, primary diseases, anticoagulation methods, and complications.
808 of the 842 patients (95.9%) underwent hemodialysis, and 34 patients (4.1%) were subjected to hemodialysis filtration. 606 hemodialysis patients (74.9%) used heparin as the anticoagulant, and the doses and using method were different among different centers. 223 patients (26.5%) used low molecular weight heparin (LMWH) with different kinds, doses and using methods. The underlying diseases included diabetes (15.1%), hypertension (9.4%), and other diseases (75.5%). There was no significant difference in the dosage of heparin among different diseases, while the dosage of LMWH was lower for the diabetes and hypertension patients. 171 patients (20.3%) had hemorrhagic tendency, and 67 patients (20.3%) suffered from thrombus. The dosage of heparin was lower in the patients with hemorrhagic tendency while no difference was found in the dosages of LMWH among the patients with different diseases. Antiplatelet agents were co-administrated in 172 hemodialysis patients (20.4%). The percentages of co-administration of antiplatelet for patients with thrombus and hemorrhagic tendency were 14% and 12.8% respectively. The dosages of heparin and LMWH were higher in the patients with co-administration than those without co-administration. Coagulation marker examination was conducted in only 385 patients (45.7%), and no difference in the frequency of coagulation marker examination was found among the patients with hemorrhagic tendency, thrombus, and other diseases.
Heparin is the main anticoagulant in hemodialysis. The anticoagulant methodology in hemodialysis is still empirical without clotting monitor and standard for usage of anticoagulants.
探讨三级甲等医院血液透析患者的抗凝方法及特点。
对北京、沈阳、哈尔滨和大连7家三级甲等综合医院的血液透析中心进行问卷调查，内容包括血液透析状况、原发疾病、抗凝方法及并发症。
842例患者中808例（95.9%）接受血液透析，34例（4.1%）接受血液滤过。606例血液透析患者（74.9%）使用肝素抗凝，不同中心的剂量及使用方法不同。223例患者（26.5%）使用低分子肝素（LMWH），种类、剂量及使用方法各异。基础疾病包括糖尿病（15.1%）、高血压（9.4%）及其他疾病（75.5%）。不同疾病间肝素用量无显著差异，而糖尿病和高血压患者的低分子肝素用量较低。171例患者（20.3%）有出血倾向，67例患者（20.3%）发生血栓。有出血倾向患者的肝素用量较低，不同疾病患者的低分子肝素用量无差异。172例血液透析患者（20.4%）联合使用抗血小板药物。有血栓和出血倾向患者的抗血小板药物联合使用率分别为14%和12.8%。联合用药患者的肝素和低分子肝素用量高于未联合用药者。仅385例患者（45.7%）进行了凝血指标检测，有出血倾向、血栓及其他疾病患者的凝血指标检测频率无差异。
肝素是血液透析中的主要抗凝剂。血液透析的抗凝方法仍为经验性，缺乏凝血监测及抗凝剂使用标准。
