连续性静脉-静脉血液滤过联合血液灌流对严重脓毒症患者凝血功能的影响

发布时间：2018-11-08 19:07

【摘要】：目的探讨连续性静脉-静脉血液滤过(CVVH)联合血液灌流(HP)对严重脓毒症患者凝血功能的影响。方法采用前瞻性研究方法。入选64例严重脓毒症有血液净化治疗指征的患者,随机分为CVVH组及CVVH+HP组,每组32例,比较两组治疗前及治疗后1、3、5 d时患者的血小板计数、凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、纤维蛋白原、凝血酶时间(TT)及D二聚体的变化。结果两组治疗后1、3、5 d均可见血小板减少;与CVVH组比较,CVVH+HP组患者血小板数量下降更显著(P0.05)。两组患者治疗后PT、APTT、TT均较治疗前稍延长,但差异无统计学意义(P0.05)。结论 CVVH及HP均会造成血小板数量的减少,但对出凝血时间无明显影响,使用低分子肝素抗凝、血液灌流器可能是其中重要的原因,在行血液净化治疗中需密切监测。
[Abstract]:Objective to investigate the effect of continuous veno-venous hemofiltration (CVVH) combined with hemoperfusion (HP) on coagulation function in patients with severe sepsis. Methods prospective study was used. 64 patients with severe sepsis were randomly divided into CVVH group and CVVH HP group with 32 cases in each group. The platelet count and prothrombin time (PT),) were compared between the two groups before and after treatment. Changes of activated partial thromboplastin time (APTT),) fibrinogen, thrombin time (TT) and D dimer. Results Thrombocytopenia was observed in both groups on the 5th day after treatment, and the platelet count in, CVVH HP group was significantly lower than that in CVVH group (P0.05). After treatment, PT,APTT,TT in both groups was slightly longer than that before treatment, but the difference was not statistically significant (P0.05). Conclusion both CVVH and HP can reduce the number of platelets, but there is no significant effect on coagulation time. The use of low molecular weight heparin (LMWH) as anticoagulant may be one of the important reasons, and should be closely monitored in the course of blood purification therapy.
【作者单位】：广东省梅州市人民医院重症医学一科;
【基金】：广东省科技计划项目(编号:20110311)
【分类号】：R459.7

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