甲磺酸萘莫司他对连续性血液净化的抗凝效果及安全性研究  

Study on the anticoagulant effect and safety of naphthalmostat mesylate on continuous blood purification

作　　者：张育安 张颜 吴成云 杨玉琼 Zhang Yu'an;Zhang Yan;Wu Chengyun;Yang Yuqiong(Department of Nephrology,the Third People's Hospital of Yunnan Province,Kunming 65001l,China;Department of Emergency,Dianchi Hospital of Yunnan Traditional Chinese Medicine,Kunming 650021,China)

机构地区：[1]云南省第三人民医院肾病科,昆明650011 [2]云南省中医医院滇池院区急诊科,昆明650021

出　　处：《国际泌尿系统杂志》2024年第3期393-398,共6页International Journal of Urology and Nephrology

摘　　要：目的:探讨甲磺酸萘莫司他与枸橼酸钠对高危出血患者行连续性血液净化治疗的抗凝效果及安全性研究。方法:选取2021年1月至2022年6月在云南省第三人民医院肾病科行连续性肾替代治疗(CRRT)的100例高危出血患者为研究对象。根据随机数字表法将患者分为甲磺酸萘莫司他组和枸橼酸钠组,每组各50例。甲磺酸萘莫司他组给予注射用甲磺酸萘莫司他抗凝,枸橼酸钠组给予枸橼酸钠抗凝。比较两组患者治疗前后的血常规、生化指标、凝血功能、透析器寿命、凝血原因、输血量、CRRT启动后60 d的生存率及抗凝剂相关不良反应。结果:治疗前,两组患者的血常规、肝功能、血肌酐(Scr)等指标比较,差异均无统计学意义(均P>0.05)。治疗后,两组患者的Scr、尿素氮(BUN)水平较治疗前明显下降,且甲磺酸萘莫司他组降幅更大,差异均有统计学意义(均P<0.05)。甲磺酸萘莫司他组患者的透析器寿命、24 h使用的滤器数量、滤器寿命>12 h占比及透析器凝血事件优于枸橼酸钠组,而持续TMP>200 mmHg患者占比、输悬浮红细胞及血小板数量低于枸橼酸钠组,差异均有统计学意义(均P<0.05)。两组患者在CRRT启动后60 d的生存时间比较,差异无统计学意义(χ^(2)=0.017,P=0.898)。甲磺酸萘莫司他组和枸橼酸钠组患者的出血加重发生率分别是12%(6/50)和10%(5/50),差异无统计学意义(χ^(2)=0.102,P=0.749)。甲磺酸萘莫司他组患者发生过敏反应2例(4%),表现为面部潮红,皮肤瘙痒,予地塞米松磷酸钠注射液抗过敏治疗后缓解,枸橼酸钠组未观察到过敏反应。结论:对于有出血风险、有肝素或低分子肝素抗凝禁忌证以及枸橼酸钠代谢受损的患者,甲磺酸萘莫司他作为CRRT的抗凝剂是安全的,且效果良好。Objective To investigate the anticoagulant effect and safety of nathomorestat mesylate and sodium citrate in patients with high-risk bleeding after continuous blood purification.Methods High-risk bleeding patients who received continuous renal replacement therapy(CRRT)in the nephrology department of the Third People's Hospital of Yunnan Province from January 2021 to June 2022 were selected as the study objects.Patients were divided into naproxat mesylate group and sodium citrate group according to random number table method,with 50 cases in each group.Naphthalmostat mesylate group was given anticoagulation,sodium citrate group was given anticoagulation.Blood routine,biochemistry,coagulation function,dialyzer life span,clotting causes,blood transfusion volume,60 days survival rate after CRRT initiation and anticoagulant related adverse reactions were compared between the two groups before and after treatment.Results Before treatment,there were no significant differences in blood routine,liver function and Scr between 2 groups(all P>0.05).After treatment,the Scr and BUN levels in 2 groups were significantly decreased compared with those before treatment,and the decrease was greater in naphthalmorestat mesylate group,with statistical significance(all P<0.05).The dialyzer life span,the number of filters used at 24 h,the proportion of filter life(more than 12 h)and the coagulation events of dialyzer were better in nathomostat mesylate group than in sodium citrate group,while the proportion of patients with continuous TMP(more than 200 mmHg)and the number of suspended red blood cells and platelets were lower than those in sodium citrate group,with statistical significance(all P<0.05).There was no significant dference in survival time at 60 days after CRRT initiation between the two groups(χ^(2)=0.017,P=0.898).The incidence of aggravated bleeding in naproxat mesylate group and sodium citrate group was 12%(6/50)and 10%(5/50),respectively,with no significant dference(χ^(2)=0.102,P=0.749).Anaphylaxis occurred in 2 patien

关 键 词：连续性肾替代疗法 出血 甲磺酸萘莫司他 抗凝药 

分 类 号：R692.5[医药卫生—泌尿科学]