阿加曲班在高危出血患者床旁血液滤过治疗中的应用研究  

Application of Argatroban in bedside hemofiltration in patients with high risk of bleeding

作　　者：王新博 杜银科[1] 耿野[1] 姚丽[1] WANG Xin-bo;DU Yin-ke;GENG Ye;YAO Li(Department of Nephrology,the First Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院肾脏内科,辽宁沈阳110001

出　　处：《中国实用内科杂志》2022年第7期577-581,共5页Chinese Journal of Practical Internal Medicine

基　　金：辽宁省重点研发指导计划(2020JH2/10300045)。

摘　　要：目的 探讨阿加曲班在有高危出血倾向的患者行床旁血液滤过治疗中的抗凝效果。方法 回顾性分析2020年1月至2021年8月在中国医科大学附属第一医院肾内科行床旁血液滤过治疗并予阿加曲班或低分子肝素钠抗凝的有高危出血风险的86例患者的临床资料,根据抗凝剂的不同分为阿加曲班组(40例)和低分子肝素钠组(46例)。比较两组患者的治疗效果、抗凝效果及出血情况等。结果 阿加曲班组患者有效治疗时间显著长于低分子肝素钠组,生理盐水冲洗量及超滤量显著低于低分子肝素钠组,差异有统计学意义(P<0.05)。血液滤过治疗后,阿加曲班组血肌酐、尿素氮、血钾、尿酸、血磷、甲状旁腺素显著低于低分子肝素钠组,纤维蛋白原、血小板计数显著高于低分子肝素钠组,差异有统计学意义(P<0.05);两组患者的血钙、凝血酶原时间、活化部分凝血酶原时间、血红蛋白差异无统计学意义(P>0.05)。两组患者滤器及管路使用寿命、滤器残余血、滤器跨膜压、收缩压、舒张压比较,差异无统计学意义(P>0.05)。阿加曲班组患者在治疗期间及治疗后24 h内均无出血事件发生。结论 阿加曲班在高危出血床旁血液滤过治疗中具有更小出血风险,其抗凝效果的充分性、有效性及安全性均较高。Objective To investigate the anticoagulant effect of Argatroban in bedside hemofiltration treatment for patients with a high risk of bleeding.Methods A total of 86 bedside hemofiltration patients with high-risk bleeding tendency were selected as prospective study subjects and divided into Argatroban group(40 cases)and low molecular weight heparin sodium group(46 cases)according to the different anticoagulants.The treatment and anticoagulant effects,bleeding status of the two groups were observed.Results The effective treatment time of the Argatroban group was longer than that of the low molecular weight heparin sodium group,and the saline flushing volume and ultrafiltration volume were lower than those of the low molecular weight heparin sodium group,and the difference was statistically significant(P<0.05).After hemofiltration treatment,the serum creatinine,blood urea nitrogen,serum potassium,uric acid,serum phosphorus and parathyroid hormone were lower than those of the low molecular weight heparin sodium group,the fibrinogen and platelet counts were significantly higher than those in the low molecular weight heparin sodium group,and the difference was statistically significant(P<0.05).There was no significant difference in serum calcium,prothrombin time,activated partial prothrombin time,and hemoglobin between the two groups(P>0.05).There was no significant difference in filter and tube life,filter residual blood,filter transmembrane pressure systolic and diastolic between the two groups(P>0.05).No bleeding events occurred in the Argatroban group during treatment and within 24 h after treatment.Conclusion Argatroban has a smaller bleeding risk in the treatment of high-risk bleeding bedside hemofiltration,and its anticoagulant effect is high in adequacy,efficacy and safety.

关 键 词：阿加曲班 低分子肝素钠 抗凝 高危出血 床旁血液滤过 

分 类 号：R973.2[医药卫生—药品]