心血管外科术后阿加曲班与肝素动静脉冲洗抗凝的疗效比较  

Efficacy of arteriovenous argatroban versus heparin flush anticoagulation after cardiovascular surgery

作　　者：曹芳芳[1] 谢恩泽华 秦竹韵 徐飞[2] 杜雨[1] 陈祖君[1] 赵锐 丘俊涛 吴进林 邱家伟 戴路 宋剑 高伟[2] 于存涛[2] Cao Fangfang;Xie Enzehua;Qin Zhuyun;Xu Fei;Du Yu;Chen Zujun;Zhao Rui;Qiu Juntao;Wu Jinlin;Qiu Jiawei;Dai Lu;Song Jian;Gao Wei;Yu Cuntao(Department of Surgical Intensive Care Unit,Fuwai Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,National Center for Cardiovascular Diseases,Beijing 100037,China;Department of Cardiovascular Surgery,Fuwai Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,National Center for Cardiovascular Diseases,Beijing 100037,China;Department of Cardiac Surgery,Guangdong Provincial People′s Hospital,Guangzhou 510080,China)

机构地区：[1]北京协和医学院、中国医学科学院、国家心血管病中心、阜外医院成人外科恢复室,北京100037 [2]北京协和医学院、中国医学科学院、国家心血管病中心、阜外医院心血管外科,北京100037 [3]广东省人民医院心脏外科,广州510080

出　　处：《中华医学杂志》2023年第28期2168-2174,共7页National Medical Journal of China

基　　金：北京协和医学院“中央高校基本科研业务费”(3332018045)

摘　　要：目的比较心血管外科术后使用阿加曲班与肝素动静脉冲洗对血小板计数的影响,并评估肝素诱导的血小板减少症(HIT)和其他并发症的发生情况。方法单中心前瞻性随机对照研究。纳入2019年3至12月中国医学科学院阜外医院心血管外科术后患者,根据术后动静脉冲洗抗凝方式分为阿加曲班组(阿加曲班2.5 mg+生理盐水250 ml)和肝素组(肝素10 mg+生理盐水250 ml),观察两组血小板计数、出血和血栓形成情况,评估HIT的4T评分、HIT抗体阳性率及其他并发症发生情况。结果共纳入491例患者,男307例,女184例,年龄(52.3±13.7)岁,阿加曲班组245例,肝素组246例。阿加曲班组与肝素组术前血小板计数M(Q_(1),Q_(3))[198.0(161.0,248.0)×10^(9)/L比194.0(157.2,243.8)×10^(9)/L,P=0.498]差异无统计学意义。重复测量方差分析结果显示,阿加曲班组与肝素组术后12 h[127.0(100.0,154.0)×10^(9)/L与121.5(90.2,149.0)×10^(9)/L]、术后1 d[126.0(97.0,162.0)×10^(9)/L与123.5(88.0,151.0)×10^(9)/L]和5 d[168.0(130.0,215.0)×10^(9)/L与161.0(101.0,210.5)×10^(9)/L]血小板计数差异无统计学意义(组间比较:F=3.327,P=0.069;时间比较:F=532.523,P<0.001;组间×时间交互作用:F=0.675,P=0.512)。阿加曲班组与肝素组4T评分≥4分的比例[9.8%(24/245)比10.6%(26/246),P=0.777]、HIT抗体阳性率[1.63%(4/245)比1.63%(4/246),P=0.726]差异均无统计学意义。与肝素组相比,阿加曲班组机械通气时间缩短[13.0(11.0,21.0)比15.5(12.0,21.0)h,P=0.020]。结论心血管外科术后常规使用阿加曲班动静脉冲洗抗凝与普通肝素相比,不影响HIT的发生率。Objective To compare the effects of arteriovenous argatroban and heparin flushes on platelet count and assess the occurrence of heparin‑induced thrombocytopenia(HIT)and other complications in patients undergoing cardiovascular surgeries.Methods A single‑center,prospective randomized control study was conducted.Patients who underwent cardiovascular surgery at Fuwai Hospital,Chinese Academy of Medical Sciences from March to December 2019 were randomly divided into the argatroban group(250 ml normal saline plus 2.5 mg of argatroban)and the heparin group(250 ml normal saline plus 10 mg of heparin).Platelet count,hemorrhage,and thrombosis were assessed.The 4T scores of HIT,the incidences of HIT and other complications were also evaluated.Results A total of 491 patients(307 males and 184 females)were included in the study,with a mean age of(52.3±13.7)years.There were 245 cases in the argatroban group and 246 cases in the heparin group,respectively.There was no statistically significant difference in the preoperative platelet count between the argatroban and heparin groups[198.0(161.0,248.0)×10^(9)/L vs 194.0(157.2,243.8)×10^(9)/L,P=0.498].Likewise,there were no statistically significant differences in the platelet count between the argatroban and heparin groups at 12 h,1 day,and 5 days after operation[127.0(100.0,154.0)×10^(9)/L vs 121.5(90.2,149.0)×10^(9)/L,126.0(97.0,162.0)×10^(9)/L vs 123.5(88.0,151.0)×10^(9)/L,168.0(130.0,215.0)×10^(9)/L vs 161.0(101.0,210.5)×10^(9)/L](repeated measures ANOVA between groups:F=3.327,P=0.069;time comparison:F=532.523,P<0.001;time interaction between groups:F=0.675,P=0.512).The proportion of 4T scores of medium and high scores(≥4)[9.8%(24/245)vs 10.6%(26/246),P=0.777]and incidence of HIT antibody positive[1.63%(4/245)vs 1.63%(4/246),P=0.726]were similar between argatroban group and the heparin group.Mechanical ventilation time was shorter in the argatroban group than that in the heparin group[13.0(11.0,21.0)vs 15.5(12.0,21.0)h,P=0.020].Conclusion Compared with heparin,r

关 键 词：心血管外科手术 抗凝药 阿加曲班 肝素 随机对照试验 

分 类 号：R654[医药卫生—外科学]