Comparison Of Different Anticoagulation Methods In Continous Venous-Venous Hemofiltration To Treat MODS Patients

Objective 1. To explore anticoagulation safty and efficacy of different methods, unfractionated heparin(UFH), low molecular weight heparin(LMWH), regional citrate anticoagulation(RCA), anticoagulation without heparin, to treat multiple organ dysfunction syndrome(MODS) in continous venous-venous hemofiltration(CVVH). 2. To compare different anticoagulated methods lead to filter and pipeline blood coagulation.Methods One hundred and thirty patients with MODS during CVVH were random divided into low-risk bleeding group(P group) and high-risk bleeding group(H group). Low-risk bleeding group contain fifty patients divided UFH groups(P-P group) and LMWH group(P-D group), twenty-five patients in each group. High-risk bleeding group have eighty patients assigned LMWH group(H-D group), unfractionated heparin+ Protamine group(UFH+ Protamine group), anticoagulation without heparin(H-W group) and RCA group(H-J group), twenty patients in each group. Changes of activated partial thromboplastin time(APTT)、prothromin time(PT)、thrombin time(TT)、platelets counts(PLT),there was difference in levels of electrolytes, acid and basic index, and blood urea nitrogen, serum creatinine and bleeding complications and the situation of filter and pipeline blood coagulation were observed.Results During the CVVH therapy, patients in the low-risk bleeding group and high-risk bleeding group were assigned to receive UFH and LMWH anticoagulation, its levels of APTT, PT and TT were prolonged compared with prior treatment, existing statistical difference(P<0.01). But the patients’ platelets counts in P-D group and H-D group were no significantly changes after treatment, without statistical difference(P>0.05).There was no statistical difference in APTT, PT, TT and PLT observed between RCA group and without heparin group in the high-risk bleeding group(P>0.05). Levels of APTT, PT and TT were prolonged between H-D group and H-P group, existing statistical difference(P<0.01). Levels of blood urea nitrogen, serum creatinine were significantly lower after CVVH treatment than before treatment, existing statistical difference(P<0.01), but there was no significantly statistical difference in levels of decrease of solute(P>0.05), there were a steady trend of electrolytes and acid and basic index after CVVH treatment.A small part of patients occurred bleeding in skin and mucosa in low-risk bleeding group, and the patients in high-risk bleeding group were utilized RCA and without heparin anticoagulation without other severe bleeding complications, but there was many patients occurred bleeding complications in the group of UFH anticoagulation. The states of coagulation within the filter and pipeline were observed that different groups occurred different degrees filter and pipeline coagulation, the incidence of coagulation within the filter and or the pipeline was highest 39.2% in the without heparin group and was lowest 15.6% in the RCA group.Conclusion According to the actual situation of the patient’s own( the primary disease) and the states of coagulation to choice relevant anticoagulation method, positive evaluation the risk of bleeding, combining the mechanism of work of anticoagulation to reasonable choice and advocating individualized anticoagulation method. Meanwhile strengthen the effective monitoring coagulation function can ensure the anticoagulant effect.