【摘要】 目的探讨改良式无肝素抗凝在高危出血倾向患者连续性静脉-静脉血液滤过(continuous venovenous hemofiltration,CVVH)应用的可行性和安全性。方法采用自身对照法将40例具有高危出血倾向行无肝素CVVH治疗的患者按治疗单、双日分为观察组和对照组,对照组采用传统无肝素抗凝治疗68例次,观察组采用改良式无肝素抗凝治疗68例次。观察两组有效治疗时间、生理盐水冲洗量、实际超滤量、治疗前后生化指标下降值、体外循环凝血及治疗后出血并发症情况。结果两组有效治疗时间、生理盐水冲洗量、实际超滤量、治疗前后生化指标下降值、滤器和静脉壶凝血情况比较,差异有统计学意义(均P<0.01)。结论对高危出血倾向患者行改良式无肝素CVVH治疗,同时做好无肝素抗凝的常规护理,不但能起到安全有效的抗凝效果,还可延长有效治疗时间、降低滤器和静脉壶凝血发生率,减轻护理工作量,节约成本。更多还原

【Abstract】 Objective To evaluate the feasibility and safety of heparin-free anticoagulation in continuous venovenous hemofiltration(CVVH) for patients at high risk of hemorrhage.Methods Using self-control method,40 cases of high bleeding tendency patients with CVVH treatments were divided into two groups.In the experimental group(odd day),68 sessions were treated with modified heparin-free anticoagulation,while 68 sessions in control group(even day) with traditional heparin-free anticoagulation without heparinization.Comparisons were conducted on effective treatment time,priming volume of saline solution,actual ultrafiltration volume,the difference of some clinical parameters between pre and post treatments,filter and venous chamber coagulation between the two groups.Results There were statistic differences on effective treatment time,priming volume of saline solution,actual ultrafiltration volume,the differences of some clinical parameters between pre and post treatments and filter and venous chamber coagulation(P<0.01).Conclusion It is safe and effective for high bleeding tendency patients with CVVH treatment when we take the improved method and implement the routine nursing cooperatively.Furthermore,it can increase the effective treatment time,decrease the priming volume of saline solution,raise the actual ultrafiltration volume,reduce the possibility of filter and venous chamber coagulation and relieve the nurse’ workload and also be cost-saving.更多还原