Ward R A, Schmidt B, Gurland H J
Division of Nephrology, School of Medicine, University of Louisville, Kentucky 40292.
ASAIO Trans. 1990 Jul-Sep;36(3):M321-4.
The ability of DEAE-cellulose (Hemophan) membranes to bind heparin may reduce bioavailable heparin and predispose to dialyzer clotting, thus preventing use of Hemophan with low-dose heparin. To examine this possibility, residual blood volumes were determined following 95 treatments with dialyzers containing Hemophan membranes in 11 patients. No heparin was added to the saline used to prime the dialyzers. The anticoagulant effect of heparin was measured using recalcified activated clotting times (RACT). Two heparin doses, calculated by a pharmacokinetic model to increase baseline RACT by 12.5% and 25%, were used for each patient. The mean heparin loading doses were 10.2 +/- 2.8 and 15.3 +/- 2.2 IU/kg, respectively, and the mean infusion rates were 11.1 +/- 3.2 and 14.7 +/- 3.2 IU/kg/h, respectively. Residual blood volumes were determined by red cell lysis and hemoglobinometry. In 88 treatments, residual blood volume averaged 1.6 +/- 1.5 ml. In the other seven treatments, residual blood volume greater than 10 ml was seen. In five of these cases, clotting appeared to propagate from the arterial drip chamber. Residual blood volume did not correlate with the level of heparin. The data show that low-dose heparin can be used with Hemophan membranes, and suggest that blood tubing design may be an important factor in blood circuit clotting during hemodialysis.
二乙氨基乙基纤维素（Hemophan）膜结合肝素的能力可能会减少可生物利用的肝素，并易于导致透析器凝血，从而妨碍低剂量肝素与Hemophan膜的联合使用。为了探究这种可能性，对11例患者使用含Hemophan膜的透析器进行95次治疗后测定了残余血量。用于预充透析器的生理盐水中未添加肝素。使用复钙活化凝血时间（RACT）来测量肝素的抗凝效果。每位患者使用两种通过药代动力学模型计算得出的肝素剂量，以使基线RACT分别增加12.5%和25%。平均肝素负荷剂量分别为10.2±2.8和15.3±2.2 IU/kg，平均输注速率分别为11.1±3.2和14.7±3.2 IU/kg/h。通过红细胞溶解和血红蛋白测定法来测定残余血量。在88次治疗中，残余血量平均为1.6±1.5 ml。在其他7次治疗中，观察到残余血量大于10 ml。在其中5例中，凝血似乎从动脉滴注室蔓延开来。残余血量与肝素水平无关。数据表明低剂量肝素可与Hemophan膜联合使用，并提示血路管设计可能是血液透析过程中血路凝血的一个重要因素。
