Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Rd., Kaohsiung, Taiwan, ROC.
Blood Purif. 2011;32(3):232-7. doi: 10.1159/000328743. Epub 2011 Aug 9.
The objective of this study was to assess the impact of heparin concentration retained in temporary double-lumen catheters on bleeding risk.
Activated partial thromboplastin time (aPTT) was measured in patients hemodialyzed via double-lumen catheters. Heparin solutions of 5,000 U/ml (group 1, n = 95) and 1,000 U/ml (group 2, n = 89) were randomly retained in catheters after placement and each hemodialysis (HD) session. Blood transfusion, bleeding episodes, and changes of hematocrit were recorded.
The aPTT at the beginning of HD or 10 min after heparin lock was significantly prolonged, which was more prominent in the 5,000 U/ml group, whereas the aPTT declined to baseline values at the end of HD or before the next dialysis session in both groups. Infection and occlusion rates were similar in both groups. More patients suffered from major bleeding and prominent decline of hematocrit in the 5,000 U/ml group.
Low-dose heparin (1,000 U/ml) retention in double-lumen catheters for temporary HD maintains comparable catheter patency and might reduce the bleeding risk.
本研究旨在评估临时双腔导管中残留肝素浓度对出血风险的影响。
对接受双腔导管血液透析的患者进行活化部分凝血活酶时间（aPTT）检测。在置管和每次血液透析（HD）后，导管中随机保留 5000U/ml（第 1 组，n=95）和 1000U/ml（第 2 组，n=89）的肝素溶液。记录输血、出血事件和血细胞比容的变化。
HD 开始时或肝素封管后 10 分钟时的 aPTT 明显延长，5000U/ml 组更为显著，而两组在 HD 结束时或下一次透析前 aPTT 降至基线值。两组的感染和阻塞发生率相似。5000U/ml 组更多的患者发生大出血和血细胞比容明显下降。
临时血液透析中双腔导管内低剂量肝素（1000U/ml）保留可保持导管通畅性相当，可能降低出血风险。
