心血管外科术后阿加曲班与肝素动静脉冲洗的抗凝效果比较  

A comparative study of the anticoagulation of arteriovenous flush by using argatroban and heparin after cardiovascular surgery

作　　者：曹芳芳[1] 张海涛[1] 张永辉[1] 周宏艳[1] 杜雨[1] 王冀[1] CAO Fang-fang;ZHANG Hai-tao;ZHANG Yong-hui;ZHOU Hong-yan;DU Yu;WANG Ji(State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China)

机构地区：[1]阜外医院SICU中国医学科学院/北京协和医学院国家心血管病中心心血管疾病国家重点实验室,北京100037

出　　处：《解放军医学杂志》2018年第6期518-522,共5页Medical Journal of Chinese People's Liberation Army

摘　　要：目的比较术后阿加曲班与肝素两种方法实施动静脉冲洗抗凝的效果,观察其是否能有效预防肝素诱导的血小板减少症(HIT)及其并发症的发生。方法回顾性分析2015年12月-2018年2月中国医学科学院阜外医院心血管外科术后患者的临床资料,根据术后抗凝的不同分为肝素动静脉抗凝组(肝素组,n=350,给予含10mg肝素的生理盐水250ml),阿加曲班动静脉抗凝组(阿加曲班组,n=396,给予含2.5mg阿加曲班的生理盐水250ml),监测两组血小板数量、肝、肾功能及凝血指标的变化,记录两组发生的出血或血栓事件,两组HIT相关4Ts评分及HIT抗体阳性患者数量及并发症发生情况。结果两组患者基础临床资料差异无统计学意义(P>0.05)。术前及术后当天两组患者血小板计数差异无统计学意义(P>0.05),术后第1天及第5天后肝素组血小板明显低于阿加曲班组[(137.7±44.8)×10~9/L vs.(144.9±49.9)×10~9/L,P=0.039;(122.8±50.0)×10~9/L vs.(135.7±57.7)×10~9/L,P=0.030)。根据4Ts评分法诊断,肝素组有13例患者4Ts为中高分,其中7例患者HIT抗体阳性(2.0%),抗体阳性患者启动标准的阿加曲班抗凝治疗。阿加曲班组有5例4Ts中高分,2例HIT抗体阳性(0.5%),启动标准的阿加曲班抗凝治疗,未发生出血事件。肝素组总体血栓事件较阿加曲班组多。术后两组肝肾功能及凝血指标差异无统计学意义(P>0.05)。结论心血管外科术后常规使用阿加曲班行动静脉冲洗抗凝对血小板数量影响小,可减少HIT的发生,同时无出血风险。Objective To compare arteriovenous flush with heparin and argatroban and observe its effect on platelet counts, biochemical index and the incidence of thrombocytopenia（HIT）. Methods Retrospective analysis for 746 cardiovascular surgery patients, who were divided into heparin group（350 cases, 10 mg heparin dissolved in 250 ml of saline） and argatroban group（396 cases, 2.5 mg argatroban dissolved in 250 ml saline）. Monitoring the changes of platelet count, hepatic function, renal function and blood coagulation index, hemorrhage and thrombosis incidence were monitored in two groups. HIT related 4 Ts score, HIT incidence and complications were also recorded. Results There was no significant difference in basic clinical data between the two groups. There was no difference in platelet counts between the two groups before and after the operation, and the platelets of heparin group were significantly lower than that of the argatroban group on the first day and the 5 th day after surgery. According to 4 Ts score, 13 patients in heparin group got medium and high score of 4 Ts, of whom 7 patients were positive for antibody（2.0%）, and then standard anti-coagulation therapy was initiated for antibody positive patients. There were 5 patients in argatroban group getting medium and high score of 4 Ts, and 2 were HIT antibody positive（0.5%）. As such, the standard anti-coagulation therapy was also performed on these patients, and no bleeding event occurred. The total number of thrombosis events were more in the heparin group than in the argatroban group. There was no statistically significant difference between the two groups in hepatic, renal function index and coagulation index. Conclusions Postoperative routine use of arteriovenous flush with argatroban for anticoagulation has litte effect on platelet count, could reduce the incidence of HIT and does not increase the risk of bleeding.

关 键 词：阿加曲班 肝素 心脏外科 

分 类 号：R654[医药卫生—外科学]