Kopeć Jerzy, Sułowicz Władysław
Katedra i Klinika Nefrologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków.
Przegl Lek. 2010;67(2):91-4.
Hemodialyzed patients with increased risk of bleeding can be dialyzed according to a method of limited anticoagulant use including saline flush technique, regional citrate anticoagulation, regional heparinization or use of membranes with low thrombogenic properties. Methods that limit anticoagulation use are not completely effective, increase work load for the dialysis team and create a risk of complications. The aim of the study was to evaluate the clinical usefulness of Nephral ST dialyzers with poli-acrylonitrile membranes treated with polyethylenimine binding heparin in hemodialyzed patients with increased risk of bleeding. In 12 patients with increased bleeding risk, 121 hemodialyzed sessions were performed utilizing Nephral ST dialyzers. Heparin was not administered during the procedure. Degree of clotting of the dialyzer and the venous drip chamber was evaluated using a 4-degree visual scale. Platelet count, partial activation time of thromboplastine (APTT), thrombin time (TT), antithrombin III, as well as d-dimer concentrations were measured before dialysis and after 15, 120 and 240 minutes of procedure. No complications of massive clotting necessitating premature termination of dialysis was noted. In most sessions trace or small clotting was observed in the dialyzers and drip chambers. No significant differences in platelet count and AT III levels were measured. Increased TT and APTT after 15 minutes of dialysis were observed, which was probably due to release of small amounts of dialyzer membrane heparin. After 120 and 240 minutes these values returned to normal ranges. These observations along with increased d-dimers after 240 minutes suggested an increased risk of clotting during evaluated sessions. Application of Nephral ST dialyzers permits for heparin-free dialysis procedure in patients with increased risk of bleeding.
出血风险增加的血液透析患者可根据有限使用抗凝剂的方法进行透析，包括生理盐水冲洗技术、局部枸橼酸抗凝、局部肝素化或使用低血栓形成特性的膜。限制抗凝剂使用的方法并不完全有效，会增加透析团队的工作量并产生并发症风险。本研究的目的是评估在出血风险增加的血液透析患者中，使用经聚乙烯亚胺结合肝素处理的聚丙烯腈膜的Nephral ST透析器的临床实用性。对12例出血风险增加的患者使用Nephral ST透析器进行了121次血液透析治疗。在治疗过程中未给予肝素。使用4级视觉量表评估透析器和静脉滴注腔的凝血程度。在透析前以及治疗15、120和240分钟后测量血小板计数、部分凝血活酶激活时间（APTT）、凝血酶时间（TT）、抗凝血酶III以及D-二聚体浓度。未观察到因大量凝血导致透析提前终止的并发症。在大多数治疗过程中，透析器和滴注腔中观察到微量或少量凝血。血小板计数和抗凝血酶III水平未测量到显著差异。透析15分钟后观察到TT和APTT增加，这可能是由于透析器膜释放少量肝素所致。120和240分钟后这些值恢复到正常范围。这些观察结果以及240分钟后D-二聚体增加表明在评估的治疗过程中凝血风险增加。应用Nephral ST透析器可允许对出血风险增加的患者进行无肝素透析治疗。
