甲磺酸萘莫司他与枸橼酸在高危出血患者CRRT中抗凝有效性和安全性对比研究  

A comparative study on the anticoagulant efficacy and safety of nathomostat mesylate and citric in patients with high risk bleeding CRRT

作　　者：陈势 黄嫣然 杨坤 Chen Shi;Huang Yanran;Yang Kun(Department of Critical Care Medicine,Wenzhou Intergrated Traditional Chinese and Western Medicine Hospital,Wenzhou,China)

机构地区：[1]温州市中西医结合医院重症医学科

出　　处：《实用休克杂志（中英文）》2024年第2期89-92,103,共5页Journal of Practical Shock

摘　　要：目的对比甲磺酸萘莫司他与枸橼酸在高危出血风险患者连续性肾脏替代治疗(CRRT)中抗凝应用的有效性和安全性。方法选取2023年1月~2023年12月本院收治的50例行CRRT的高危出血风险患者为研究对象。根据抗凝剂种类分为甲磺酸萘莫司他组(n=25)和枸橼酸组(n=25)。采集透析前后患者的血液标本,对比两组的凝血功能[血小板(PLT)、血红蛋白(HGB)、活化部分凝血活酶时间(APTT)水平、激活全血凝固时间(ACT)]、酸碱平衡及电解质平衡情况,并记录两组滤器寿命、透析时间及不良反应发生情况。结果甲磺酸萘莫司他组滤器寿命为(11.60±3.12)h,枸橼酸组滤器寿命为(15.24±3.43)h,甲磺酸萘莫司他组滤器寿命低于枸橼酸组(t=3.925,P<0.001)。CRRT治疗前后,两组患者PLT、HGB、APTT、ACT比较均无显著差异(P>0.05)。CRRT治疗前后,两组患者pH、Na^(+)、K^(+)比较均无显著差异(P>0.05)。甲磺酸萘莫司他组患者1例患者发生消化道出血,枸橼酸组患者1例发生枸橼酸积蓄,所有患者经对症处理后均恢复稳定。结论甲磺酸萘莫司他与枸橼酸的抗凝效果相当,对于行CRRT治疗的高危出血风险患者的凝血功能、酸碱平衡及电解质平衡均无明显影响,且具有一定安全性,对于具有枸橼酸禁忌证的患者而言是良好的替代方案。Objective To compare the efficacy and safety of naproxat mesylate and citric acid in continuous renal replacement therapy(CRRT)for patients at high risk of bleeding.Methods From January 2022 to December 2023,50 patients with CRRT at high risk of bleeding were selected as the study objects.According to the types of anticoagulants,they were divided into naphthalmostat mesylate group(n=25)and citric acid group(n=25).The blood samples of patients before and after dialysis were collected,and the coagulation function(platelet(PLT),hemoglobin(HGB),activated partial thromboplastin time(APTT),activated whole blood coagulation time(ACT)),acid-base balance and electrolyte balance of the two groups were compared,and the filter life,dialysis time and adverse reactions of the two groups were recorded.Results The filter life of namostat mesylate group was(11.60±3.12)h,and that of citric acid group was(15.24±3.43)h.The filter life of Namostat mesylate group was lower than that of citric acid group(t=3.925,P<0.001).Before and after CRRT treatment,there were no significant differences in PLT,HGB,APTT and ACT between 2 groups(P>0.05).Before and after CRRT treatment,there were no significant differences in pH,Na^(+)and K^(+)between 2 groups(P>0.05).Digestive tract hemorrhage occurred in 1 patient in the naphthalmostat mesylate group,and citric acid accumulation occurred in 1 patient in the citric acid group.All patients recovered to stability after symptomatic treatment.Conclusions Naproxat mesylate has the same anticoagulant effect as citric acid,and has no significant effect on coagulation function,acid-base balance and electrolyte balance in high-risk bleeding risk patients treated with CRRT,and has certain safety,which is a good alternative for patients with citric acid contraindications.

关 键 词：甲磺酸萘莫司他 枸橼酸 连续性肾脏替代治疗 抗凝 

分 类 号：R459.5[医药卫生—治疗学]