小剂量阿加曲班在高危出血风险血液透析患者中的应用  

Application of low-dose argatroban in hemodialysis patients with high risk of bleeding

作　　者：邱德俊[1] 高卓[1] 李新伦[1] 胡瑞海[1] 伦立德[1] QIU Dejun;GAO Zhuo;LI Xinlun(Department of Nephrology,Air Force Medical Center of PLA,Beijing 100142,China)

机构地区：[1]北京空军特色医学中心(原空军总医院)肾病科

出　　处：《河北医药》2019年第24期3704-3707,3712,共5页Hebei Medical Journal

摘　　要：目的 观察小剂量阿加曲班在高危出血风险血液透析患者中的安全性及抗凝效果。方法 选取2016年2月至2019年5月具有活动性出血或出血倾向的61例血液透析患者,随机分为阿加曲班组(30例)和无肝素组(31例),阿加曲班组采用滤器前持续泵入小剂量(0.69 μg·kg-1·min-1)阿加曲班,透析结束前30 min停泵,无肝素组采用6 250 U/L肝素盐水冲洗透析器及管路30 min,上机前用生理盐水冲洗管路。将2级凝血以下视为抗凝有效,观察滤器及静脉壶抗凝有效率,检测透析前后凝血功能、血小板计数的变化,观察阿加曲班组透析过程中不同时间段活化部分凝血活酶时间(APTT)的变化。观察透析前后动脉压,静脉压及跨膜压的变化。记录患者生命体征,透析器凝血及临床出血事件。结果 阿加曲班组所有患者均顺利完成4h血液透析,无肝素组中6例次因凝血较重提前下机,占19%。无肝素组HD后D-二聚体(D-dimer)轻度升高,血小板计数下降,与HD前相比差异有统计学意义(P<0.05),而阿加曲班组无上述改变。静脉壶及滤器抗凝有效率无肝素组明显低于阿加曲班组(P<0.05),静脉压、跨膜压无肝素组均高于阿加曲班组(P<0.05)。阿加曲班组HD 2h滤器前、后及HD后 APTT较HD前均增加30%左右(P<0.05),而HD后1 h基本回归基线,较HD前略增高[(34.42±3.3)s,(31.78±2.73)s,P<0.05],但处于正常范围内。2组均未发生明显出血事件及不良反应。结论 对于高危出血风险的血液透析患者,小剂量阿加曲班抗凝安全、有效,与无肝素相比更具优势。Objective To investigate the safety and anticoagulant effects of low-dose argatroban in hemodialysis(HD)patients with high risk of bleeding.Methods A total of 61 patients with active bleeding or bleeding tendency who were treated in our hospital from February 2016 to May 2019 were enrolled in the study,who were randomly divided into argatroban group (n=30) and heparin-free group (n=31). The patients in argatroban group were treated by continuously pumping a low dose (0.69μg·kg-1·min-1) of argatroban before the filter,and the pump was stopped at 30 minutes before the end of HD,however,the patients in heparin-free group were treated by using 6,250U/L heparin saline flushing dialyzer and extracorporeal circuit for 30 minutes,with flushing with saline again before the HD began.The anticoagulation effects,which were defined as the filter and venous bubble trap below coagulation level 2,and the effective rate of anticoagulant,and the changes in coagulation function and platelet count before and after dialysis,as well as the change of activated partial thromboplastin time (APTT) at different time points and the changes of arterial pressure,venous pressure and transmembrane pressure before and after dialysis were observed and compared between the two groups.And the patients’ vital signs,dialyzer coagulation and clinical bleeding events were also observed and compared between the two groups.Results All the patients in argatroban group underwent successfully the 4h HD.However 6 cases in heparin-free group quit due to extracorporeal circuit heavier coagulation,which accounted for 19%.The D-dimer levels were slightly increased and the platelet count was decreased in heparin-free group after HD,there was a significant difference before HD and after HD (P<0.05),however, no obvious changes were found in argatroban group.The anticoagulation effects of venous bubble trap and filter in heparin-free group were significantly lower than those in argatroban group (P<0.05).The APTT levels before and after filter of HD 2h and at th

关 键 词：血液透析 阿加曲班 无肝素 高危出血 

分 类 号：R459.5[医药卫生—治疗学]