CAJ | 학술논문

目的：观察不同对策下血液净化中肝素（或低分子肝素）诱导的血小板减少症（HIT）发生及治疗情况，为相关的临床治疗提供依据。方法：选择血液净化患者34例，分为低分子肝素组24例和鱼精蛋白中和肝素组10例，观察治疗前后血小板变化情况及HIT发生率。并观察在连续静脉-静脉血液滤过（CVVH）和连续静脉-静脉血液滤过+血液灌流（CVVH+HP）不同血液净化方式下，血小板计数的变化情况。结果：低分子肝素组与肝素+鱼精蛋白组血液净化结束时血小板水平较血液净化前均减低，低分子肝素组降低更明显，两组比较差异有统计学意义（P<0.05）。CVVH和CVVH+HP两种血液净化方式对血小板数量的影响差异无统计学意义（P>0.05）。结论：血液净化中应用鱼精蛋白中和肝素抗凝法，能减少对血小板的破坏，有效地预防HIT的发生，安全可行，值得临床推广。
목적：관찰불동대책하혈액정화중간소（혹저분자간소）유도적혈소판감소증（HIT）발생급치료정황，위상관적림상치료제공의거。방법：선택혈액정화환자34례，분위저분자간소조24례화어정단백중화간소조10례，관찰치료전후혈소판변화정황급HIT발생솔。병관찰재련속정맥-정맥혈액려과（CVVH）화련속정맥-정맥혈액려과+혈액관류（CVVH+HP）불동혈액정화방식하，혈소판계수적변화정황。결과：저분자간소조여간소+어정단백조혈액정화결속시혈소판수평교혈액정화전균감저，저분자간소조강저경명현，량조비교차이유통계학의의（P<0.05）。CVVH화CVVH+HP량충혈액정화방식대혈소판수량적영향차이무통계학의의（P>0.05）。결론：혈액정화중응용어정단백중화간소항응법，능감소대혈소판적파배，유효지예방HIT적발생，안전가행，치득림상추엄。
Objective:To investigate the incidence rate and effects of different treatments of heparin-induced thrombocytopenia (HIT) during blood purification. Methods:34 patients with blood purification were divided into two groups. One group was treated with low molecular weight heparin (LMWH) and the other was treated with heparin and protamine. Platelet change and HIT rates were observed before and after the treatment. The change of platelet was also observed in the different way of blood purification (CVVH vs CVVH+HP). Results: PLT both reduced in the two groups, but the PLT of patients with low molecular weight heparin was lower than that of patients with heparin and protamine. The difference was statistically significant (P<0.05). And there was no significant difference of PLT change between CVVH and CVVH+HP (P>0.05). Conclusion:Heparin anticoagulation with protamine neutralization can help to reduce the destruction of platelets and prevent HIT effectively. It is safe and feasible for clinical promotion.