阿加曲班在重症急性胰腺炎连续性血液净化治疗中的疗效观察  

The clinical observation of argatroban in severe acute pancreatitis with continuous blood purification treatment

作　　者：徐智会 张文军[1] 代越[1] 刘永富[1] 王林恒[1] 龚光远 颜晓佳[1] 王艳[1] 

机构地区：[1]重庆市綦江区人民医院重症医学科,401420

出　　处：《检验医学与临床》2016年第11期1474-1476,1479,共4页Laboratory Medicine and Clinic

基　　金：重庆市卫生和计划生育委员会医学科研计划项目(20143062)

摘　　要：目的观察阿加曲班在重症急性胰腺炎(SAP)患者连续性血液净化治疗中的临床疗效。方法将该院收治的162例SAP患者根据血液净化治疗过程中抗凝选择的不同随机分为普通肝素组(53例)、枸橼酸钠组(54例)和阿加曲班组(55例)。观察各组治疗前后生化指标、炎性细胞因子变化、血凝指标及病情严重程度,进一步观察并发症及不良反应发生情况。结果各组患者治疗72h后血尿素氮(BUN)、肌酐(Cr)、丙氨酸氨基转移酶(ALT)及血淀粉酶(AMS)比较差异无统计学意义(P>0.05);与治疗前相比,各组患者治疗后C反应蛋白(CRP)、白细胞介素(IL)-6、IL-8、肿瘤坏死因子-α(TNF-α)水平均明显降低(P<0.05),其中阿加曲班组较普通肝素组和枸橼酸钠组降低更明显(P<0.05);与普通肝素组和枸橼酸钠组比较,阿加曲班组治疗后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)及国际标准化比值(INR)显著升高,纤维蛋白原(FBG)则显著降低(P<0.05);阿加曲班组治疗后急性生理与慢性健康状况评分(APACHEⅡ评分)(8.1±0.9)分明显低于普通肝素组(10.2±1.2)分和枸橼酸钠组(9.9±1.0)分,差异有统计学意义(P<0.05);3组并发症及出血评分比较,差异无统计学意义(P>0.05)。结论阿加曲班在SAP患者连续性血液净化治疗过程中显示出显著的临床疗效,值得临床进一步运用推广。Objective To observe the clinical efficacy of argatroban in severe acute pancreatitis（SAP）with continuous blood purification treatment.Methods According to the different anticoagulated methods in blood purification treatment process,a total of 162 cases SAP patients in our hospital were randomly divided into common heparin group（53cases）,sodium citrate group（54cases）,argatroban group（55cases）.The biochemical indicators,cytokines,blood coagulation index level and severity of disease before and after treatment were measured,and the adverse effect and complication were further observed.Results The blood urea nitrogen（BUN）,creatinine（Cr）,alanine aminotransferase（ALT）and serum amylase（AMS）levels after 72 htreatment in each group had no significantly difference（P〈0.05）;Compared with before treatment,the levels of C-reactive protein（CRP）,interleukin-6（IL-6）,interleukin-8（IL-8）and tumor necrosis factor（TNF-α）after treatment were significantly lower in each group（P〈0.05）,but argatroban group were lower than the common heparin group and sodium citrate group（P〈0.05）.Compared with the common heparin group and sodium citrate group,the PT,APTT,TT and INR after treatment in argatroban group was significantly higher,but FBG was lower（P〈0.05）.The Acute Physiology and Chronic Health Evaluation（APACHE Ⅱ）score after treatment were significantly lower in argatroban group（8.1±0.9）than common heparin group（10.2±1.2）and sodium citrate group（9.9±1.0）,P〈0.05.The difference in bleeding scores and complication among the three groups was not statistically significant（P〈0.05）.Conclusion The argatroban shows a significant clinical efficacy in SAP patients with continuous blood purification treatment,which is worthy of further clinical use and promotion.

关 键 词：阿加曲班 重症急性胰腺炎 连续性血液净化 临床疗效 

分 类 号：R59[医药卫生—内科学]