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体外循环抗凝是保证尿毒症透析病人顺利透析的重要手段,目前大多数透析病人均使用肝素抗凝,低分子肝素抗凝比例在不断上升[1]。研究[2]证实低分子肝素比普通肝素更具安全性。我国透析病人低分子肝素推荐使用的剂量为60~80 U/kg[3],但此数据缺乏国内循证医学数据支撑,更多按照欧美国家的指南进行推荐。中国人群应该使用多大剂量的肝素对血液透析病人进行抗凝,一直是个悬而未决的问题[4],这也导致了各透析中心肝素的使用剂量差异[5]。为此本研究对我中心透析病人进行了单中心横断面的回顾性分析,观察低分子肝素使用剂量对血透病人的预后影响。现作报道。
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Perason相关分析显示,肝素使用剂量与Hb水平呈正相关关系(r=0.213,P < 0.05)。
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Perason相关分析显示,肝素用量与EPO用量呈负相关关系(r=-0.225,P < 0.05)。
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低剂量组与高剂量组血液透析病人透析期间的肺部感染、消化系统出血及心脑血管事件的发生率差异均无统计学意义(P>0.05)(见表 1)。
分组 n 肺部感染 消化系统出血 心脑血管事件 是 否 是 否 是 否 低剂量组 75 12(16.00) 63(84.00) 10(13.33) 65(56.67) 17(22.67) 58(77.33) 高剂量组 33 5(15.15) 28(84.85) 6(18.18) 27(81.82) 13(39.39) 20(60.61) χ2 — 0.01 0.43 3.20 P — >0.05 >0.05 >0.05 表 1 2组病人肺部感染、消化系统出血及心脑血管事件发生风险比较[n;百分率(%)]
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低剂量组病人铁蛋白和转铁蛋白饱和度明显高于高剂量组(P < 0.01),2组其他指标差异均无统计学意义(P>0.05)(见表 2)。
分组 n iPTH/(pg/mL) KT/V β2微球蛋白/(mg/L) URR/(%) Ca/(mmol/L) P(mmol/L) 透析前收缩压/mmHg 透析前
舒张压/mmHg透析后
收缩压/mmHg透析后
舒张压/mmHgAlb/(g/L) 铁蛋白/(g/L) 转铁蛋白
饱和度/%低剂量组 75 375.53±300.40 1.36±0.30 43.50±14.66 69.15±11.95 2.17±0.54 1.57±0.51 142.49±12.98 77.08±9.62 149.71±16.65 78.78±11.33 38.31±3.94 508.29±241.26 64.64±22.80 高剂量组 33 291.88±152.79 1.38±0.34 41.27±23.79 69.25±12.65 2.02±0.31 1.62±0.63 142.50±13.62 76.67±6.91 149.42±19.57 78.63±8.23 39.70±2.97 322.88±211.51 39.03±21.06 t — 1.91* 0.31 0.50* 0.04 1.82* 0.44 0.00 0.25* 0.08 0.08* 1.81 3.82 5.63 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 < 0.01 < 0.01 *示t′值 表 2 2组临床指标比较(x±s)
不同剂量低分子肝素对维持性血液透析病人的预后影响
Effect of different doses of low-molecular-weight heparin on the prognosis of the maintenance hemodialysis patients
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摘要:
目的探讨不同剂量的低分子肝素对维持性血液透析病人肺部感染、消化系统出血、心脑血管事件发生的影响,并分析肝素使用剂量与临床指标的相关关系,为指导临床个体化使用低分子肝素提供理论依据。 方法单中心横断面回顾性分析108例维持性血液透析病人的低分子肝素使用剂量与其各临床指标的相关性;并按单位体质量低分子肝素使用剂量将病人分为2组(低剂量组:低分子肝素使用剂量 < 40 IU/kg;高剂量组:低分子肝素使用剂量≥40 IU/kg),分析2组病人发生肺部感染、消化系统出血及心脑血管事件风险及各临床指标的差异。 结果血液透析病人单位体质量低分子肝素用量与血红蛋白水平呈正相关关系(r=0.213,P < 0.05);低分子肝素用量与促红细胞生成素使用剂量呈负相关关系(r=-0.225,P < 0.05)。低剂量组与高剂量组肺部感染发生率、消化系统出血发生率、心脑血管事件发生率差异均无统计学意义(P>0.05);低剂量组病人铁蛋白和转铁蛋白饱和度明显高于高剂量组(P < 0.01),2组其他临床指标差异均无统计学意义(P>0.05)。 结论低分子肝素的使用剂量对血液透析病人的肺部感染、消化系统出血、心脑血管事件风险无明显影响;低分子肝素用量越大的血液透析病人,具有更高的血红蛋白水平及更低的促红细胞生成素使用剂量的特点。 Abstract:ObjectiveTo explore the effects of different doses of low-molecular-weight heparin (LMWH) on the pulmonary infection, digestive system bleeding and incidence of cardiovascular and cerebrovascular events, analyze the correlation between the dose of heparin and clinical indicators, and provide theoretical basis for guiding the individualized use of LMWH in maintenance hemodialysis patients. MethodsThe correlation between the dose of heparin and clinical indicators in 108 patients treated with maintenance hemodialysis was analyzed using the single-center cross-section study.The patients were divided into the low-dose group (treatment with the dosage of LMWH < 40 IU/kg) and high-dose group (treatment with the dosage of LMWH ≥40 IU/kg).The differences of the pulmonary infection, bleeding of digestive system, incidence of cardiovascular and cerebrovascular events, and clinical indicators were compared between two groups. ResultsThe results of Pearson correlation analysis showed that the LMWH dosage per unit body mass was positively correlated with hemoglobin level (r=0.213, P < 0.05), and the LMWH dosage was negatily correlatied with erythropoietin in patients treated with maintenance hemodialysis (r=-0.225, P < 0.05).There was no statistical significance in the incidence rates of pulmonary infection, digestive system bleeding, and cardiovascular and cerebrovascular events between two groups (P>0.05).The levels of ferritin and transferrin saturation in low-dose group were greater than those in high-dose group (P < .01), and the differences of other clinical indicators between two groups were not statistically significant (P>0.05). ConclusionsThe dose of LMWH has no significantly impact on the risks of pulmonary infection, digestive system bleeding and cardiovascular and cerebrovascular events.The greater the hemoglobin usage is, the higher the hemoglobin levels and the lower the erythrotropin dose are. -
Key words:
- hemodialysis /
- low-molecular-weight heparin /
- anemia /
- prognosis
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表 1 2组病人肺部感染、消化系统出血及心脑血管事件发生风险比较[n;百分率(%)]
分组 n 肺部感染 消化系统出血 心脑血管事件 是 否 是 否 是 否 低剂量组 75 12(16.00) 63(84.00) 10(13.33) 65(56.67) 17(22.67) 58(77.33) 高剂量组 33 5(15.15) 28(84.85) 6(18.18) 27(81.82) 13(39.39) 20(60.61) χ2 — 0.01 0.43 3.20 P — >0.05 >0.05 >0.05 表 2 2组临床指标比较(x±s)
分组 n iPTH/(pg/mL) KT/V β2微球蛋白/(mg/L) URR/(%) Ca/(mmol/L) P(mmol/L) 透析前收缩压/mmHg 透析前
舒张压/mmHg透析后
收缩压/mmHg透析后
舒张压/mmHgAlb/(g/L) 铁蛋白/(g/L) 转铁蛋白
饱和度/%低剂量组 75 375.53±300.40 1.36±0.30 43.50±14.66 69.15±11.95 2.17±0.54 1.57±0.51 142.49±12.98 77.08±9.62 149.71±16.65 78.78±11.33 38.31±3.94 508.29±241.26 64.64±22.80 高剂量组 33 291.88±152.79 1.38±0.34 41.27±23.79 69.25±12.65 2.02±0.31 1.62±0.63 142.50±13.62 76.67±6.91 149.42±19.57 78.63±8.23 39.70±2.97 322.88±211.51 39.03±21.06 t — 1.91* 0.31 0.50* 0.04 1.82* 0.44 0.00 0.25* 0.08 0.08* 1.81 3.82 5.63 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 < 0.01 < 0.01 *示t′值 -
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