小剂量阿加曲班与小剂量普通肝素在高出血风险患者CRRT期间抗凝治疗的对比研究  

A comparative study of small - dose argatroban and unfractionated heparin for anticoagulationtherapy in CRRT patients with high risk of bleeding

作　　者：许晓文 曹捷 唐莲[3] 陆件[1] 沈奕[1] 庄智伟[1] 

机构地区：[1]南京医科大学附属苏州医院急诊科,江苏苏州215002 [2]南京医科大学康达学院药学系,江苏连云港222000 [3]南京医科大学附属苏州医院药学部

出　　处：《中国急救医学》2018年第2期174-178,共5页Chinese Journal of Critical Care Medicine

基　　金：江苏省药学会奥赛康基金项目（201511）

摘　　要：目的探讨小剂量阿加曲班与小剂量普通肝素在高出血风险患者连续性。肾脏替代治疗（CRRT）中的抗凝疗效及安全性。方法回顾性分析2015—02～2017—04南京医科大学附属苏州医院住院的113例行CRRT的高出血风险患者，阿加曲班组86例，肝素组27例。监测患者CRRT前、CRRT期间、CRRT后的凝血功能及相关检验指标，评估滤器管路凝血事件、同时观察患者出血情况等。结果①疗效分析：阿加曲班组CRRT期间的活化部分凝血活酶时间（APTT）（87．10±38．89）S与CRRT前（56．30±22．83）S相比差异有统计学意义（P=0．000），但是CRRT后的AFIT与CRRT前相比差异无统计学意义；肝素组CRRT后的APTT（84．95±44．47）S较高，与阿加曲班组（62．30±28．30）S相比差异有统计学意义（P=0．016）。②阿加曲班组与肝素组凝血事件分别为11．9％和8．4％，差异无统计学意义（P=0．350）；阿加曲班组的肌酐下降率（40．0±18．7）％比肝素组（12．3±13．7）％更大。差异有统计学意义（P=0．012）。③安全性分析：阿加曲班组和肝素组的出血事件发生率分别为7．0％和22．2％，差异有统计学意义（P：0．025），均未观察到有严重的出血事件。CRRT前后血小板计数和血红蛋白差异无统计学意义。结论与普通肝素相比，阿加曲班具有相当的抗凝效果，CRRT结束后凝血功能可较快恢复，发生出血事件较少，是危重症高出血风险患者CRRT期间抗凝用药的较好选择。Objective To explore the anticoagulant efficacy, security of small - dose argatroban and unfractionated heparin in continuous renal replacement therapy （CRRT） patients with high risk of bleeding. Methods There were totally 113 cases involved in this retrospective study： 86 patients in argatroban group and 27 patients in the heparin group. Before, during and after CRRT, the patient＇s coagulation indexes, the filter tube clotting events, bleeding events and other laboratory indicators were collected. Results Efficacy analysis ： In argatroban group, AFFT during CRRT were prolonged when compared to that before CRRT, and had statistical difference （P = 0. 000） , but APTT after CRRT had no statistical difference when compared to before CRRT. Compared to argatroban group, AFIT after CRRT in heparin group were more prolonged （P = 0. 016）.The filter tube clotting events in argatroban andheparin groups were 11.9% and 8.4% , and had no statistical differences （P = 0. 350）. The range of creatinine decrease in argatroban group was higher than that in the heparin group, and had statistical difference （P = 0. 012）. @Safety analysis： The rates of bleeding events were 7.0% and 22.2% in the group of argatroban and heparin group, and had statistical difference （P = 0. 025）. No severe bleeding events were observed in each group. Before and after CRRT, platelet and hemoglobin had no statistical difference. Conclusion Compared with heparin, argatroban has a good anticoagulant effect and less bleeding events, the coagulant function can be recovered quickly after CRRT. Argatroban is a better choice for critically ill oatients with hizh risk of bleedine in CRRT.

关 键 词：阿加曲班 肝素 连续性肾脏替代治疗(CRRT) 高出血风险 

分 类 号：R743.33[医药卫生—神经病学与精神病学]