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Objective To observe MAR S artificial liver treatment of liver failure heparin circulation and heparin cycle technology on patient outcomes, the number of blood cells, bleeding and clotting impact; try initially established MARS the anticoagulants application in the treatment of liver failure safe mode and individualized treatment standards. Methods A prospective experimental study law. Artificial liver treatment center line of MARS treatment to August 2009 to August 2010 in Xiangya Hospital of Central South University of liver failure patients for the study, according to the different anticoagulant way to randomly divided into two groups: heparin group and the heparin group , no timing saline irrigation piping, to ensure the speed of blood flow, strengthen monitoring heparin group means of intervention, such as clotting clinical need for the use of anticoagulant drugs under doctor's orders plus anticoagulation, early termination of the trial. The heparin group uses half the amount of first dose (2050U) to the full amount of the low molecular weight heparin (4100U), intraoperative intermittent anticoagulation. Two groups before surgery postoperative liver function (Tbil DbiLA), renal function (BUN, SCR), blood cell count (RBC, Hb, BPC) compared to the choice of treatment Oh (before treatment), 30Min, 1h, 2h , 3h, 4h, 5h, 6h (ie, the end of treatment) a total of eight point in time dynamic changes observed PT, PTA, TT, APTT, INR coagulation indicators observed piping / filter clotting, rupture, bleeding, and other adverse events frequency of occurrence and severity. SPSS18.0 statistical package for statistical analysis of the data. Statistical methods included descriptive statistical analysis, independent samples t-test and analysis of variance, analysis of covariance. Results on August 1.2009 to August 2010 Xiangya Hospital artificial liver treatment centers completed MARS treatment of 45 cases, 32 cases meet the inclusion criteria for cases, 32 cases of treatment times. Single treatment duration of 6 hours, the heparin group, 18 cases were successfully completed treatment, 1 patient with severe clotting times in 14 cases of non-heparin group treatment interruption, the three cases to be added due to coagulation anticoagulant drugs for early termination of the trial. Two groups of patients to accept both the depth of jaundice before MARS treatment, significantly lower than the normal low serum protein, RBC, Hb, BPC count below the normal low value of PTA lt; 40%, significantly prolonged PT, TT, APTT, two no difference between the groups before treatment. The two groups decreased the difference is no difference in performance combined Tbil, DbiL, BUN, SCR protein toxins and water-soluble toxins significantly decreased in both groups. 4. Heparin group before treatment RBC.Hb were 3.21 ± 0.78 × 1012 / l, 102.52 ± 21.586g / L, 3.02 ± 0.81 × 1012 / l, 97.08 ± 22.73 g / L, heparin treatment after treatment before RBC , Hb were 3.49 ± 0.66 × 1012 / l, 102.50 ± 35.24 g / L, after treatment, 3.28 ± 0.64 × 1012 / l, 107.10 ± 15.45 g / L, and the two groups no significant decline, no statistically significant difference. Heparin group therapy before BPC 107.86 ± 104.54 × 109 / L after treatment is 94.86 ± 108.26 × 109 / L (t = 1.826, P = 0.083), non-heparin group therapy the former BPC to 86.70 ± 52.37 × 109 / L After treatment, 60.60 ± 32.78 × 109 / L, and (t = 2.782, P = 0.021). No heparin group BPC decrease was statistically significant. 6 two sets of PT, PTA, INR analysis of variance was no difference in APTT, TT. Fbg significant difference. APTT: heparin group after the first dose of anticoagulant drugs APTT increased rapidly, reached the peak, 30min, heparin group also rose, but the speed is relatively slow, the median of the treatment in the two groups at each time point APTT was statistically significant ( t = 2.201, P = 0.036). TT: heparin group after the first dose of anticoagulant drugs TT also showed increased rapidly, reached the peak, 30min, 4h second peak again, but less than the first time, the end of the treatment is still ten pretreatment levels. No heparin group to maintain a steady state, the the median TT's treatment in the two groups at each time point more significant difference (t = 3.287, P = 0.003). Fbg: two sets of MARS treatment the Fbg change curve interaction (F = 3.630, P = 0.001), more significant differences. The heparin group Fbg stabilized and increased slightly at the end of treatment, no heparin group the Fbg gradually decreased treatment for 6 hours to reduce significantly, both in the treatment of 2.5h cross. Heparin group, six cases of grade Ⅰ clotting, cases of Ⅱ degree clotting, intraoperative bleeding, bleeding after two cases; six cases of non-heparin group Ⅰ degree clotting did not occur, patients with stage Ⅲ degree coagulation, intraoperative and postoperative bleeding. Were no allergic Case. With no statistically significant difference (P = 0.845). Conclusion 1.MARS that the treatment of liver failure, of heparinized cycle and no heparin cycle can cause BPC decline without heparin circulation decline is higher than heparinized cycle. 2.PTA important indicators to determine liver failure patients coagulation, but not the sole criterion. MARS treatment requires a combination of a comprehensive analysis of the the BPC, FDP, D-dimer laboratory testing and clinical symptoms, determine the coagulation status choose anticoagulant way. Hypercoagulable period Select heparin cycle implementation MARS hypercoagulable state help cardiopulmonary bypass successfully completed at the same time to improve prevention DIC. Low pour Choice heparin circulation can be effective in preventing the occurrence of bleeding, and improve the patient's clotting mechanism by lowering blood in heparin-like substances.
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