血栓弹力图在连续肾替代治疗抗凝检测中的应用

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1、授予单位代码10089学号或申请号13382K^(E^A^HebeiMedicalUniversity硕士学位论文在职科学学位血栓弹力图在连续肾替代治疗抗凝检测中的应用学位申请人：苗晓云导师：胡振杰教授专业：急诊医学二级学院：第四医院2015年3月河北医科大学学位论文使用授权及知识产权归属承诺本学位论文在导师(或指导小组)的指导下，由本人独立完成。本学位论文研究所获得的研究成果,其知识产权归河北医科大学所有。河北医科大学有权对本学位论文进行交流、公开和使用。凡发表与学位论文主要内容相关的论文，第一署名为单位河北医科大学，

2、试验材料、原始数据、申报的专利等知识产权均归河北—f所有。否则,承担相应法律责任。X^！Mi;髮‘‘.%：研究生签名成夂导师签章二级学.i‘搞：仗河北医科大学研究生学位论文独创性声明本论文是在导师指导下进行的研究工作及取得的研究成果，除了文中特别加以标注和致谢等内容外，文中不包含其他人已经发表或撰写的研究成果,指导教师对此进行了审定。本论文由本人独立撰写，文责自负。研究生签名：爲辟^导师签章：>4年J月1日目录中文摘要··················································

3、···························1英文摘要·············································································3研究论文血栓弹力图在连续肾替代治疗抗凝监测中的应用前言·············································································5材料与方法···········································

4、·························5结果·············································································7附图·············································································9附表···········································································

5、··11讨论·············································································12结论·············································································16参考文献·······································································16综述连续性肾脏替代治疗的抗凝与监测···

6、································19致谢···················································································29个人简历·············································································30中 文 摘 要血栓弹力图在连续肾替代治疗抗凝监测中的应用摘要目的：肝素是目前全球血液净化治疗的主要抗凝剂，传统应用部分

7、凝血酶原时间（Applicationofpartialthromboplastintime，APTT）监测凝血功能调整肝素用量，但患者出血风险和滤器寿命的改善并不理想。快速血栓弹力图（Rapidthromboelastograph，rTEG）是从凝血因子、血小板、纤溶系统功能方面，动态监测全血凝血状态的一种检验方法。本研究应用常规APTT联合快速血栓弹力图评估连续肾替代治疗患者肝素抗凝的效果，指导调整肝素剂量，以改善滤器凝血，降低患者出血风险。方法：本研究选取沧州市中心医院重症医学科在2014年3月---2014年12月

8、收治的应用连续肾替代治疗（continuousrenalreplacementtherapy，CRRT）治疗的患者，排除应用抗凝剂、活动性出血、肝素抗凝禁忌、肝功能衰竭患者，共选取病例40例，随机分为2组，实验组20例应用APTT联合rTEG肝素酶对比试验凝血因子激活时间（activetime，ACT）时间缩短率（A