| Objective: Comparing the coagulation routine before and after dialysis and anticoagulant dose after dialysis for high risk of bleeding hemodialysis patients of abnormal coagulation routine and need surgery, discussing and analyzing relevant law of coagulation function and anticoagulant dose.Method: Collected the cases with complete information of abnormal coagulation routine and need surgery at high risk of bleeding of 50 patients with acute and chronic renal failure during the period of treatment from July 2011 to February 2014 in our hospital. determination of treatment before and after the prothrombin time(PT), prothrombin activity(PA), prothrombin ratio(R), international standardization ratio(INR), activated partial clotting enzyme live time(APTT), fibrinogen(FIB), thrombin time(TT),and the aftering dialysis anticoagulant treatment dose, grouped and compared according to age, gender,different way of dialysis and other indicators.Results: Including 50 patients in this research, which 28 cases were male accounting for 56% and the average age was 58.36±14.708.The female were 22 cases accounting for 44% and the average age was 62.64±14.679.The sex ratio of people is 1.27:1.The patients with acute renal failure were 17 cases, which are accounting for 34% and the chronic renal failure were 33 cases taking up 66%. The results showed that there were no statistical differences comparatively between male and female at PT, PA,R, INR, APTT and FIB, which were grouped by sex(P>0.05).TT of men group average was 20.17±2.48 s and the relative group average was 22.95±4.20 s.Female group was significantly higher than male group, Significant difference(P = 0.013). In this study, elderly patients with PT, INR and TT were relatively shorter but the APTT and FIB were higher than young and middle-aged group, but there were no significant differences. The result of CVVH and CVVHDF group in blood coagulation function comparison was no significant statistical difference. The age of each group classified by different ways of dialysis was statistically significant different(P=0.028).The age of CVVHDF group patients was older than CVVH group’s. The standards of PT, TT prolong and the FIB raised in the Chronic renal insufficiency group and TT had a significant difference between the two groups(P = 0.028). There were 34 cases in good prognosis, 16 in bad prognosis, with an average age of 55.43±18.09 and 66.81±10.85. The age of two groups had significant difference(P=0.025).Comparing the blood coagulation function of two groups, TT of bad prognosis group was shorter than the control group(P=0.037).The age of difference in A and B groups(Less than the average dose low molecular heparin group as A group, as group B was greater than the average dose group) was not significant(P>0.05).Two groups of patients with PT(P = 0.022), PA(P = 0.008), R(P = 0.024), INR(P = 0.020) had significant differences. For some patients of blood coagulation dysfunction, the first dose of low molecular heparin was 35U/kg, additional dose was 18U/kg, which can assure the process of blood dialysis treatment safety and effectivity. The PT, APTT, TT of Low molecular heparin group were prolonged after treatment, but only TT was statistically significant(P = 0.018).The PT, TT of without heparin group after treatment were shorter than before treatment, and the APTT, FIB were longer and higher, but no difference statistically among all groups(P > 0.05). The treatment time of two groups, the average time of Low molecular heparin group was 7.91±1.20 h and without heparin group was 7.40±1.18 h, no obvious statistical significance between the two groups(P > 0.05).Conclusion: The thrombin time of women was longer than men for renal failure patients who are at high risk of bleeding. That is reminded that the risk of blood clots or hyperfibrinolysis in female may be higher than male patients. The kind of dialysis of CVVHDF is more frequent in Elderly patients, that may be associated with this kind of way is more safe and effective. Patients with chronic renal failure prone to blood system related complications and most probably associated with prolonged bleeding. The age is no doubt that one of the poor prognostic factors for Patients with renal failure. The older the age of patients, the higher the rate of poor prognosis and the high coagulation state for poor prognosis of patients was significantly higher than good group. So, monitoring blood coagulation had clinical value for the evaluation of the prognosis. It can appropriately reduce the recommended dose of low molecular heparin, under the precondition of guarantying the unobstructed extracorporeal circulation in process of dialysis and the dialysis sufficiency for patients of blood coagulation dysfunction. Application of low molecular heparin or without heparin anticoagulation of CRRT treatment for patients at high risk of bleeding, it can be secure and efficient under little influence on blood coagulation system. |
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