萘莫司他与阿加曲班在≥75岁病人连续性肾脏替代治疗期间的抗凝效果对比  

Comparison of anticoagulation effects between nafamostat and argatroban during continuous renal replacement therapy in elderly patients aged≥75 years old

作　　者：王婷[1] 李敏[2] 曾萍 柴春艳 赵媛[1] 李彦玲[1] WANG Ting;LI Min;ZENG Ping;CHAI Chun-yan;ZHAO Yuan;LI Yan-ling(The First Ward of West District,Shaanxi Provincial People’s Hospital,Xi’an 710068,China;Department of Health Care of Cadre,Shaanxi Provincial People’s Hospital,Xi’an 710068,China)

机构地区：[1]陕西省人民医院西院一病区,陕西省西安市710068 [2]陕西省人民医院干部保健办公室,陕西省西安市710068

出　　处：《实用老年医学》2023年第12期1224-1227,1232,共5页Practical Geriatrics

基　　金：陕西省重点研发计划项目(2021SF-352,2022SF-059)。

摘　　要：目的探讨阿加曲班与萘莫司他(nafamostat,NM)在≥75岁病人连续性肾脏替代治疗(CRRT)期间的抗凝疗效及安全性。方法12例≥75岁病人行CRRT期间分别应用阿加曲班、NM抗凝治疗各4次,记录每种抗凝治疗后3次的监测数据。监测病人CRRT前后外周血BUN、肌酐(Cr)、Hb、PLT、活化部分凝血活酶时间(APTT),以及治疗4、8 h时静脉端、动脉端的APTT,统计CRRT期间滤器管路凝血事件及病人的出血情况。结果2组CRRT前后BUN、Cr、PLT差值差异均无统计学意义(P>0.05),Hb、APTT差值差异均有统计学意义(P<0.01)。2组透析器及管路凝血情况分级差异无统计学意义(P=0.40)。NM组大便隐血发生率显著低于阿加曲班组(P=0.03),2组痰中带血、血尿发生率差异无统计学意义(P>0.05)。治疗4、8 h时,2组管道静脉端血APTT差异无统计学意义(P>0.05),但NM组动脉端血APTT较阿加曲班组明显下降(P<0.01)。结论NM具有与阿加曲班相当的抗凝效果,且对CRRT过程中、结束后体内凝血功能无显著影响,对Hb影响小,是≥75岁病人CRRT期间抗凝用药的较好选择。Objective To investigate the anticoagulation efficacy and safety of argatroban and nafamostat(NM)during continuous renal replacement therapy(CRRT)in the patients aged≥75 years old.Methods Twelve patients aged≥75 years old treated with argatroban and NM for 4 times respectively during CRRT were enrolled in this study.The monitoring data of the last 3 times of the two kinds of anticoagulant therapy were statistically analyzed.The levels of blood urea nitrogen(BUN),creatinine(Cr),hemoglobin(Hb),platelet count(PLT)and activated partial thromboplastin time(APTT)were detected before and after CRRT,and the level of APTT at venous and arterial ends 4 h and 8 h after treatment were also detected.The incidence rates of clotting events in filter tubes and bleeding during CRRT were recorded.Results There were no significant differences in the D-value of BUN,Cr and PLT between the two groups before and after CRRT(all P>0.05).There was no significant difference in the classification of dialyzer and tube coagulation between the two groups(P=0.40).The incidence rate of fecal occult blood in NM group was significantly lower than that in argatroban group(P=0.03),and there were no significant differences in the incidence rates of blood in sputum or hematuria between the two groups(P>0.05).After treatment,the level of Hb in argatroban group was significantly decreased compared to NM group(P<0.01),and the level of APTT in peripheral blood in argatroban group was significantly increased compared to NM group(P<0.01).Affter 4 h and 8 h of treatment,there were no significant differences in the level of APTT at venous end between the two groups(P>0.05),but the level of APTT at arterial end in NM group was significantly lower than that in argatroban group(P<0.01).Conclusions NM has considerable anticoagulant effect comparable to argatroban,with no significant effect on coagulation function during and after CRRT,and has less effect on Hb.It is a better choice for anticoagulants during CRRT in the patients aged≥75 years old.

关 键 词：连续性肾脏替代治疗 萘莫司他 阿加曲班 凝血功能 

分 类 号：R629.5[医药卫生—整形外科]