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目的探讨大剂量肝素盐水预冲在肾衰竭伴高危出血患者透析中的应用效果。方法选取2010年8月—2013年8月九江学院附属医院收治的肾衰竭伴有高危出血患者80例,随机分为研究组与对照组,各40例。对照组患者透析前予以临床常规操作,研究组患者透析前予以大剂量肝素盐水预冲。观察两组患者透析器和管路凝血分级、透析前、透析2h及透析后试管方法测定凝血时间(CT),心理状态及透析超滤情况。结果研究组患者透析器及管路凝血分级优于对照组,差异有统计学意义(P<0.05);两组患者透析前、透析2h及透析后CT比较,差异无统计学意义(P>0.05);研究组患者心理状态优于对照组,差异有统计学意义(P<0.05);研究组患者达目标超滤量率高于对照组,超滤量增加200~400ml、401~600ml、601~1000ml率低于对照组,差异均有统计学意义(P<0.05)。结论大剂量肝素盐水预冲在肾衰竭伴高危出血患者透析中的应用效果显著,可降低出血风险,提高患者舒适度,且安全、有效。
Objective To investigate the application of high-dose heparin saline pre-puncture in dialysis of patients with renal failure and high-risk hemorrhage. Methods Eighty patients with renal failure and high-risk bleeding admitted to Jiujiang University Affiliated Hospital from August 2010 to August 2013 were randomly divided into study group and control group, 40 cases in each group. Patients in the control group were given routine clinical practice before dialysis. Patients in the study group were pre-treated with high-dose heparin saline before dialysis. The dialyzer and pipeline coagulation and grading of the two groups were observed before dialysis, dialysis 2h and after dialysis tube method to determine the clotting time (CT), psychological status and dialysis ultrafiltration. Results In the study group, the dialyzer and coagulation grade were better than those in the control group (P <0.05). There was no significant difference between the two groups before dialysis, dialysis for 2 hours and post-dialysis CT (P> 0.05) ). The psychological status of the study group was better than that of the control group (P <0.05). The target ultrafiltration rate of the study group was higher than that of the control group. The ultrafiltration volume increased by 200-400 ml, 401-600 ml, 601 ~ 1000ml lower than the control group, the difference was statistically significant (P <0.05). Conclusion The application of high-dose heparin saline pre-puncture in the dialysis of patients with renal failure and high-risk hemorrhage has significant effect, which can reduce the risk of bleeding and improve patient comfort, and is safe and effective.