阿加曲班辅助治疗急性肾损伤并高危出血观察  

Observation of Argatroban in Adjuvant Treatment of the Patients with Acute Kidney Injury at High Risk of Bleeding

作　　者：夏璐[1] 张晓玲[1] 马旭[1] 朱清[1] 

机构地区：[1]河南省人民医院肾病风湿免疫科,河南郑州450003

出　　处：《现代临床医学》2015年第6期426-428,共3页Journal of Modern Clinical Medicine

基　　金：河南省医学科技攻关项目(201203125)

摘　　要：目的:探究阿加曲班辅助治疗急性肾损伤合并高危出血患者临床疗效,为临床研究提供参考。方法:选择2012年5月至2013年8月期间收治的80例急性肾损伤合并高危出血患者,按照随机数字表法分为实验组和对照组,各40例。实验组患者选用阿加曲班作为抗凝剂,对照组患者采取无肝素透析。比较2组患者透析前后凝血指标的变化,观察分析2组患者治疗后透析器凝血程度分级状况、穿刺点的平均压迫时间与出血次数。结果:实验组透析前、透析3 h、透析结束后1 h的APTT值与PT值改变与对照组患者比较均无显著性差异(P>0.05)。实验组患者透析3 h的APTT值与PT值与透析前、透析后比较均显著升高(P<0.05),说明实验组患者运用阿加曲班治疗具有较好的抗凝效果,且具有一定的安全性。经过透析,实验组患者与对照组患者的透析次数无显著性差异(P>0.05),但实验组患者出现透析器凝血0级343例次,Ⅰ级37例次,Ⅱ级0例,Ⅲ级0例,各个分级例次数与对照组比较均具有显著性差异(P<0.05)。经统计,实验组与对照组透析时的穿刺点平均压迫时间与出血次数比较无显著性差异(P>0.05)。结论:采用阿加曲班作为抗凝剂对急性肾损伤合并高危出血患者进行透析,透析前后其APTT、PT等凝血指标变化无显著性差异,透析器凝血状况良好,穿刺点压迫时间与出血次数较少,具有较好的临床安全性,值得在临床上广泛推广。Objective：To explore the efficacy of argatroban in adjuvant treatment of the patients with acute kidney injury at high risk of bleeding;to provide a reference for clinical research .Methods：From May 2012 to August 2013,80 cases of acute kidney injury at high risk of bleeding ,were randomly divided into experimental and control groups ,40 cases each.Experimental group had argatroban as an anticoagulant , control group had heparin -free as dialysis were taken .The coagulation indicators , dialyzer clotting condition grade level and puncture point average compression time and bleeding times were analyzed in the two groups before and after dialysis .Results：The experimental group in pre -dialysis, dialysis 1 h,3 h,APTT values and PT value changed;but compared with the control group ,there was no difference after the end of dialysis （P〉0.05）;the experimental group in 3 h dialysis,APTT values and PT values were relatively increased significantly than pre -dialysis （ P〈0.05）.Argatroban anticoagulant therapy had a better effect , and a certain security;the dialysis number of patients had no difference in the experimental group than that in the control group after dialysis （P〉0.05）,but in the experimental group ,dialyzer clotting 0 class had 343 cases,class Ⅰ 37 例,Ⅱclass 0 cases,class Ⅲ 0 cases;each classification in the experimental group had significant difference than that in control group （ P 〈0.05 ）;but puncture point average compression time and bleeding times wereno significant difference in the two groups （P〉0.05）.Conclusion：The use of argatroban as an anticoagulant in patients of dialysis with acute kidney injury at high risk of bleedingget their APTT , PT and other coagulation no significant difference ,dialyzer clotting being in good condition and oppression puncture being less bleeding with better clinical safety ,should be popularized in clinical practice.

关 键 词：阿加曲班 肝素 急性肾损伤 连续性血液净化 

分 类 号：R692[医药卫生—泌尿科学]