Yang Song-tao, Wu Hong, Gao Xiao-yun, Hu Jun, Xiao Yue-fei
Department of Nephrology, Aerospace Central Hospital & Aerospace Clinical Medical College of Peking University, Beijing 100049, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2013 Aug 18;45(4):625-9.
To assess the blood coagulation function and investigate the appropriate dose of unfractionated heparin by thromboelastograph in maintenance hemodialysis (MHD) patients.
Thirty MHD patients were enrolled in this study and divided into two groups. The total dose of unfractionated heparin was below 80 u/kg in the low-dose group (LH, n=16), while it exceeded 80 u/kg in the high-dose group (HH, n=14). Blood routine tests and conventional coagulation examinations were measured before hemodialysis. TEG and activated partial thromboplastin time (APTT) were examined at the beginning and the end of hemodialysis at the arterial circuit, and the second hour (h 2) at the venous circuit.
The initial bolus dose of unfractionated heparin for LH and HH groups were (26.6±6.2) u/kg vs. (42.3±8.2) u/kg and the repeated maintenance dose for both the groups were (13.7±5.1) u/kg/h vs. (18.2±4.3) u/kg/h. No significant difference was noticed in results from blood routine tests and conventional coagulation parameters between the two groups. In LH group, the increase of APTT at h 2 of hemodialysis was significant compared with the baseline, while it recovered partly at the end of hemodialysis. R value prolonged at h 2 and the end of hemodialysis. CI value was more negative at the end of hemodialysis. In HH group, APTT obviously prolonged at h 2 and the end of hemodialysis. R value also obviously prolonged at h 2 of hemodialysis. At the end of hemodialysis, R and K values prolonged, MA value reduced, and CI value was more negative. APTT was significantly different between the two groups at h 2 of hemodialysis. At the end of hemodialysis, APTT was still extended in HH group, but there was no significant difference. R value at h 2, and R, K, MA, CI values at the end of hemodialysis were significantly different between the two groups. R values at the end of hemodialysis had a direct correlation with the dose of unfractionated heparin (r=0.403, P=0.041), but APTT had not. There was no significant difference in transmembrane pressure, venous pressure and filter clotting between the two groups.
Low-dose heparin is effective and safe as anticoagulant in hemodialysis. TEG shows that the blood coagulation function is more sensitive than conventional coagulation parameters and is useful to anticoagulant therapy in MHD patients.
通过血栓弹力图评估维持性血液透析（MHD）患者的凝血功能，并探讨普通肝素的合适剂量。
30例MHD患者纳入本研究，分为两组。低剂量组（LH，n = 16）普通肝素总剂量低于80 U/kg，高剂量组（HH，n = 14）总剂量超过80 U/kg。血液透析前进行血常规检查和常规凝血检查。在血液透析开始时、结束时于动脉端回路以及透析2小时（h 2）时于静脉端回路检测血栓弹力图（TEG）和活化部分凝血活酶时间（APTT）。
LH组和HH组普通肝素初始推注剂量分别为（26.6±6.2）U/kg对（42.3±8.2）U/kg，两组重复维持剂量分别为（13.7±5.1）U/（kg·h）对（18.2±4.3）U/（kg·h）。两组血常规检查结果和常规凝血参数无显著差异。LH组透析2小时时APTT较基线显著升高，透析结束时部分恢复。透析2小时及结束时R值延长。透析结束时CI值更负。HH组透析2小时及结束时APTT明显延长。透析2小时时R值也明显延长。透析结束时，R和K值延长，MA值降低，CI值更负。透析2小时时两组APTT有显著差异。透析结束时，HH组APTT仍延长，但无显著差异。透析2小时时R值以及透析结束时R、K、MA、CI值两组间有显著差异。透析结束时R值与普通肝素剂量呈正相关（r = 0.403，P = 0.041），但APTT无相关性。两组间跨膜压、静脉压和滤器凝血无显著差异。
低剂量肝素作为血液透析抗凝剂有效且安全。TEG显示凝血功能比常规凝血参数更敏感，对MHD患者的抗凝治疗有用。
