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目的观察慢性重型肝炎患者在连续性血液净化治疗中使用肝素抗凝的临床安全性、监测指标变化。方法10例慢性重型肝炎患者连续性血液净化治疗72h,于治疗前、后定期观察患者的病情,检测全血活化部分凝血活酶时间(APTT)、凝血酶原活动度(PTA)、激活凝血酶原时间(ACT)、血常规等。结果患者耐受性良好,4例出现静脉置管处渗血。在治疗过程中PTA明显下降,治疗24～72h下降最为显著。治疗开始后APTT、ACT、PLT和HB均有所降低(P值分别为0.1102、0.3135、0.0728、0.1004)。结论慢性重型肝炎连续性血液净化治疗中使用肝素抗凝安全有效,但必须结合APTT、ACT、PTA和患者情况综合决定肝素用量。治疗过程中未发生严重出血、过敏等不良反应。
Objective To observe the clinical safety of heparin anticoagulation in patients with chronic severe hepatitis treated by continuous blood purification and monitor the changes of the indexes. Methods Ten patients with chronic severe hepatitis were treated with continuous blood purification for 72 hours. The patients’ condition was observed before and after treatment. The activated partial thromboplastin time (APTT), prothrombin activity (PTA), activated thrombin The original time (ACT), blood and so on. Results Patients were well tolerated, and 4 cases had venous catheterization. During the treatment of PTA decreased significantly, the treatment of 24 ~ 72h decreased the most significant. APTT, ACT, PLT and HB decreased after the treatment started (P values were 0.1102,0.3135,0.0728,0.1004 respectively). Conclusion Heparin anticoagulation is safe and effective in the treatment of chronic severe hepatitis with continuous blood purification. However, it is necessary to determine the amount of heparin in combination with APTT, ACT, PTA and patients. No serious bleeding, allergies and other adverse reactions occurred during the treatment.