|本期目录/Table of Contents|

[1]邓星平,曾庆波,胡炜,等.肝素酶修饰的血栓弹力图用于血液净化时肝素监测的临床研究[J].医学研究与战创伤救治(原医学研究生学报),2018,20(05):476-479.[doi:10.3969/j.issn.1672-271X.2018.05.006]
　DENG Xing-ping,ZENG Qing-bo,HU Wei,et al.Application of heparinase-modified thromboelastography monitoring heparin during continuous blood purification[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2018,20(05):476-479.[doi:10.3969/j.issn.1672-271X.2018.05.006]
点击复制

肝素酶修饰的血栓弹力图用于血液净化时肝素监测的临床研究()
分享到62.8K

《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第20卷
期数:
2018年05期
页码:
476-479
栏目:
出版日期:
2018-09-18

文章信息/Info

Title:
Application of heparinase-modified thromboelastography monitoring heparin during continuous blood purification
作者:
邓星平; 曾庆波; 胡炜; 林青伟; 陈涛; 宋景春; 钟林翠; 张昕
作者单位：330002南昌，解放军第九四医院重症医学科（邓星平、曾庆波、胡炜、林青伟、陈涛、宋景春、钟林翠、张昕）
Author(s):
DENG Xing-ping;  ZENG Qing-bo;  HU Wei;  LIN Qing-wei;  CHEN Tao;  SONG Jing-chun;  ZHONG Lin-cui;  ZHANG Xin
（Intensive Care Unit, the 94th Hospital of Chinese PLA, Nanchang 330002, Jiangxi, China）
关键词:
血液净化; 肝素酶修饰的血栓弹力图; 肝素; 凝血
Keywords:
continuous blood purification;  heparinase-modified thromboelastography;  heparin;  coagulation
分类号:
R446.11
DOI:
10.3969/j.issn.1672-271X.2018.05.006
文献标志码:
A
摘要:
目的 研究肝素酶修饰的血栓弹力图(hmTEG)用于持续性血液净化（CBP）时肝素监测的临床价值。方法 选取2017年9月至2018年5月解放军第九四医院重症医学科进行CBP治疗时应用肝素抗凝的50例患者，依据CBP抗凝时采用部分活化凝血酶原时间（APTT）监测或hmTEG监测，将患者分为APTT组（19例）和TEG组（31例），比较2组患者血液净化前后序贯性器官衰竭评分(SOFA)评分差值、血液净化时间、肝素总剂量与出血并发症(包括置管处、口腔、鼻腔、胃肠道等部位)情况。结果 与APTT组肝素总剂量[45(20～62.5)mg]相比，TEG组的肝素总剂量[73.5(29～84.5)mg]明显增加(P<0.05)；与APTT组的血液净化时间[23(14～29.5)h]相比，TEG组的血液净化时间[26.8(20.00～47.25)h]明显延长(P<0.05)；与APTT组的SOFA评分减少差值(1.16±1.15)相比，TEG组的SOFA评分差值(2.16±0.95)明显增加(P<0.05)；2组间出血并发症比较差异无统计学意义（P>0.05）。结论 应用hmTEG监测CBP时的肝素剂量可以延长滤器使用时间，疗效优于使用APTT监测。
Abstract:
Objective To investigate the clinical values of heparinase-modified thromboelastography(hmTEG) monitoring heparin during continuous blood purification.Methods The 50 cases of CBP were selected in the intensive care unit of the 94th People＇s Liberation Army Hospital from Sep 2017 to May 2018.The patients were divided into TEG group (31 cases) and APTT group (19 cases) according to different means of monitoring during continuous blood purification. Complication of bleeding, CBP time, heparin total dose and ΔSOFA score of the patients were compared.RusultsCompared with the heparin total dose[73.5(29-84.5)mg] and CBP time [26.8 (20.00-47.25)h] of TEG group, the heparin total dose [45(20-62.5)mg] and CBP time[23(14-29.5)h] of APTT group were significantly lower (P<0.05). Compared with the ΔSOFA(2.16±0.95) of TEG group, the ΔSOFA(1.16±1.15) of APTT group were significantly lower (P<0.05).Conclusion Using hmTEG to monitor heparin during CBP is superior to APTT.

参考文献/References:

[1]王质刚.血液净化学[M].2版.北京:北京科学技术出版社,2003:88-98.
[2]Matsuo T， Wanaka K．Management of uremic patients with heparin-induced thrombocytopenia requiring hemodialysis ［J］．Clin Appl Thromb Hemost，2008，14（4）：459-464.
[3]Lance.A general review of major global coagulation assays:thrombelastography, thrombin generation test and clot waveform analysis[J].Thromb J,2015,12(13):1.
[4]Ostrowski SR,Windelov NA,Ibsen M,et al.Consecutive thrombelastography clot strength profiles in patients with severe sepsis and their association with 28-day mortality:a prospective study[J].J Crit Care,2013,28(3):317.el-11.
[5]Da Luz LT，Nascimento B，Rizoli S．Thrombelastography (TEGW)：practical considerations on its clinical use in trauma resuscitation[J]．Scand J Traum Res Emerg Med，2013，21：29.
[6]宋景春. 脓毒症合并弥散性血管内凝血的机制与监测[J].医学研究生学报，2017,30（7）：703-708.
[7]Bambrah RK，Phan DC．Heparin-induced thrombocytopenia［J］．Clin Adv Hematol Oncol，2011，9(8):594-599.
[8]Tsai MH, Fang YW, Leu JG. Tinzaparin provides lower lipid profiles in maintenance hemodialysis patients:a cross-sectional observational study[J]. Scientif World J, 2014, 2014:486781.
[9]Tolwani AJ, Wille KM. The clinical application of CRRT—current status[J]. Semin Dial, 2009, 22(2):107.
[10]Stucker F, Ponte B, Tataw J,et al. Efficacy and safety of citrate -based anticoagulation compared to heparin in patients with acute kidney injury requiring continuous renal replacement therapy:a randomized controlled trial[J]. Crit Care，2015,19:91.
[11]Chaven JJ,Foley DE,Sinder CC,et al.A novel thrombelastograph tissue factor/kaolin assay of activted clotting times for monitoring heparin anticoagulation during cardiopulmonary bypass[J].Anesth Analg,2004,99 (5):1290-1294.
[12]Coppell JA,Thalheimer U,Zambruni A,et al.The effects of unfractionated Heparin,low molecular weight heparin and danaparoid on the thromboelastogram(TEG):an invitro comparison of standard and heparinase-modified TEGs with conventional coagulation assays[J].Blood Coagul Fibrin,2006,17(2):97-104.
[13]Artang R,Frandsen NJ,Nielsen JD,et al.Application of basic and composite thrombelastography parameters in monitoring of the antithrombotic effect of the low molecular weight heparin dalteparin:an in vivo study[J].Trauma,2012,65(6):535-543.
[14]杨松涛，吴虹，高晓云，等．应用血栓弹力图评价血液透析患者肝素剂量[J]．北京大学学报（医学版），2013,45（4）：625-629.
[15]Coppell JA, Thalheimer U, Zambruni A, et al. The effects of unfractionated heparin, low molecular weight heparin and danaparoid on the thromboelastogram (TEG):an in-vitro comparison of standard and heparinase-modified TEGs with conventional coagulation assays[J]. Blood Coagul Fibrinolysis，2006,17(2):97-104.

相似文献/References:

[1]李玉生,聂时南.松香水中毒致死1例[J].医学研究与战创伤救治(原医学研究生学报),2011,13(06):543.
[2]金娥,陈珺,陈丽珍,等.新型冠状病毒肺炎疫情期间血液净化室防控实践[J].医学研究与战创伤救治(原医学研究生学报),2020,22(5):558.[doi:10.3969/j.issn.1672-271X.2020.05.028]

备注/Memo

备注/Memo:
基金项目：江西省卫生计生委科技计划（20185556）
更新日期/Last Update: 2018-09-20