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目的:观察ICU中高出血风险患者进行床旁血液滤过治疗的不同抗凝方法的安全性及可行性。方法:将57例符合纳入标准的患者随机分为抗凝组(n=24例)和无抗凝组(n=33例),比较2组患者血液滤过过程中管路及滤器的使用寿命、清除效率及出血发生率。结果:使用肝素加鱼精蛋白的抗凝组与无抗凝组进行比较,显示抗凝组管路寿命明显延长,清除肌酐效果更好,差异有统计学意义(P<0.05)。另抗凝组造成活化部分凝血活酶时间(APTT)延长,血小板下降发生率增加(P<0.05),但血滤治疗后的出血发生率差异无统计学意义(P>0.05)。结论:ICU中高出血风险患者进行床旁血液滤过治疗时给予肝素加鱼精蛋白的抗凝方式是相对安全的,保证了治疗效果,达到了治疗目标。
Objective: To observe the safety and feasibility of different anticoagulation methods for bedside hemofiltration in patients with high bleeding risk in ICU. Methods: Fifty-seven patients eligible for inclusion were randomly divided into anticoagulation group (n = 24) and non-anticoagulation group (n = 33). The service life of tubing and filter during the hemofiltration was compared between the two groups , Removal efficiency and bleeding rate. Results: The heparin plus protamine anticoagulation group compared with no anticoagulant group showed that anticoagulant group significantly longer pipeline life, clear creatinine better, the difference was statistically significant (P <0.05). In the other anticoagulant group, the activated partial thromboplastin time (APTT) prolonged and the incidence of thrombocytopenia increased (P <0.05). However, there was no significant difference in the incidence of hemorrhage after hemoperfusion (P> 0.05). Conclusion: The anticoagulant method of heparin plus protamine in patients with high hemorrhage risk in ICU is relatively safe, which ensures the therapeutic effect and achieves the therapeutic goal.