低分子肝素在人工肝治疗肝衰竭患者时的临床应用

肝脏 ›› 2023, Vol. 28 ›› Issue (9): 1024-1027.

低分子肝素在人工肝治疗肝衰竭患者时的临床应用

汤汝佳, 胡彦明, 姚红宇, 邢汉前, 周霞, 王开利, 刘鸿凌, 赵军

100039 北京解放军总医院第五医学中心肝病医学部

收稿日期:2023-05-11 出版日期:2023-09-30 发布日期:2023-10-24
通讯作者: 刘鸿凌,Email: lhl7125@sina.com;赵军,Email:zhj68@263.net
作者简介:共同第一作者:胡彦明
基金资助:
北京市科委项目(Z161100000116058)

The application of low molecular heparin in the treatment of liver failure patients with non-biological artificial liver system

TANG Ru-jia, HU Yan-ming, YAO Hong-yu, XING Han-qian, ZHOU Xia, WANG Kai-li, LIU Hong-ling, ZHAO Jun

Senior Department of Hepatology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China

Received:2023-05-11 Online:2023-09-30 Published:2023-10-24
Contact: LIU Hong-ling, Email:lhl7125@sina.com; ZHAO Jun, Email:zhj68@263.net

摘要/Abstract

摘要： 目的观察人工肝治疗肝衰竭患者时低分子肝素(LMWH)应用的抗凝效果及安全性。方法选取2021年6月至2022年6月在解放军总医院第五医学中心行双重血浆分子吸附系统(DPMAS)联合血浆置换(PE)治疗的肝衰竭患者81例。根据治疗过程中LMWH抗凝效果分为抗凝良好组、抗凝不足组及抗凝过量组,比较不同的LMWH剂量组抗凝效果良好的比例、以及三组患者的基线水平。结果 81例患者中,男性65例,平均年龄54.55岁,HBV感染41例,共进行DPMAS联合PE治疗161例次,均顺利完成。其中抗凝良好组131例次,抗凝不足组9例次,抗凝过量组21例次。三组患者的性别、年龄、治疗前TBil、Alb等差异均无统计学意义(P值分别为0.712、0.658、0.079和0.057)。当PTA＞30％、PLT＞40×10⁹/L时,LMWH抗凝效果良好比例＞83％;抗凝不足组患者HB和PLT水平显著高于抗凝良好组(均P<0.01);与抗凝良好组相比,抗凝过量组患者的PTA、HB 明显降低,INR值升高(P<0.01、<0.01和0.027)。治疗结束24 h内,18例次患者出现中心静脉置管处渗血,3例次出现牙龈出血,均未发生消化道出血等其他严重并发症。结论 DPMAS+PE治疗时应依据治疗前PTA和PLT水平,给予不同剂量LMWH,同时应考虑HB对抗凝效果影响。

关键词: 肝衰竭, 人工肝, 低分子肝素, 凝血

Abstract: Objective To observe the anticoagulation effect and safety of low molecular heparin (LMWH) in liver failure patients treated with artificial liver system.Methods A total of 161 liver failure patients treated with dual plasma molecular adsorption system (DPMAS) combined with plasma exchange (PE) from June 2021 to June 2022 were selected. They were divided into a well-anticoagulated group, an under-anticoagulated group, and an over-anticoagulated group based on the anticoagulant effect of LMWH during treatment. The proportion of patients with good anticoagulation in different LMWH dose groups and the baseline levels of patients in the three groups were compared. Results Of the 81 patients, 65 were male, with a mean age of 54.55 years and 41 were hepatitis B virus (HBV) infected. A total of 161 DPMAS combined with PE treatments were performed and all were successfully completed. Among them, 131 were in the good anticoagulation group, 9 in the insufficient anticoagulation group and 21 in the over-anticoagulation group. There were no significant differences in gender, age, baseline level of total bilirubin (TBil) and albumin (Alb) among the three groups (P values were 0.712, 0.658, 0.079 and 0.057, respectively). When prothrombin avtivity (PTA)>30% and platelet (PLT) > 40×10⁹/L, the proportion of LMWH with good anticoagulative effect was > 83%; hemoblobin (HB) and PLT levels were significantly higher in patients in the under-anticoagulated group than in the well-anticoagulated group (all P values were 0.000); compared with the well-anticoagulated group, patients in the over-anticoagulated group had significantly lower PTA and HB and higher international normalized ratio (INR) values (P values were 0.000, 0.000 and 0.027). Within 24 hours prior the end of treatment, 18 patients experienced blood leakage from the central venous line and 3 experienced gingival bleeding, but no other serious complications such as gastrointestinal bleeding occurred. Conclusion When patients with early liver failure and good PLT levels are treated with DPMAS+PE, different doses of LMWH should be given according to the pre-treatment PTA and PLT levels, and the effect of HB on anticoagulation should also be considered.

Key words: Liver failure, Artificial liver, Low molecular heparin, Coagulation

汤汝佳, 胡彦明, 姚红宇, 邢汉前, 周霞, 王开利, 刘鸿凌, 赵军. 低分子肝素在人工肝治疗肝衰竭患者时的临床应用[J]. 肝脏, 2023, 28(9): 1024-1027.

TANG Ru-jia, HU Yan-ming, YAO Hong-yu, XING Han-qian, ZHOU Xia, WANG Kai-li, LIU Hong-ling, ZHAO Jun. The application of low molecular heparin in the treatment of liver failure patients with non-biological artificial liver system[J]. Chinese Hepatolgy, 2023, 28(9): 1024-1027.

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