萘莫司他与枸橼酸钠抗凝在脓毒症患者连续性肾脏替代治疗中的应用分析  

Analysis of the effects and prognosis using nafamostat and sodiuml citrate anticoagulant in sepsis patients with CRRT

作　　者：赵敏敏 李长秀 高菲 ZHAO Min-min;LI Chang-xiu;GAO Fei(ICU-2,Tai’an City Central Hospital,Tai’an 271000,China;不详)

机构地区：[1]泰安市中心医院综合ICU二区,山东泰安271000 [2]山东第一医科大学第二附属医院药剂科,山东泰安271000 [3]山东第一医科大学第二附属医院ICU一区,山东泰安271000

出　　处：《中国处方药》2024年第9期122-127,共6页Journal of China Prescription Drug

摘　　要：目的对比脓毒症患者连续性肾脏替代治疗(CRRT)应用甲磺酸萘莫司他及枸橼酸钠抗凝剂的抗凝疗效与预后。方法收集2022年5月~2023年9月于泰安市中心医院因脓毒症合并急性肾损伤(AKI)接受CRRT治疗,体外抗凝剂使用甲磺酸萘莫司他或枸橼酸钠抗凝剂患者的临床资料,根据使用体外抗凝剂的不同分为萘莫司他组以及枸橼酸钠组,采用回顾性分析法比较两组的一般情况,接受CRRT治疗24 h后白细胞介素-6(IL-6)、降钙素原(PCT)、白细胞(WBC)数值,存活患者PCT降至正常范围所需要的时间,7、14、21以及28 d住院生存率,使用总滤器套数及滤器使用时间以及CRRT第一套滤器在72 h内寿命情况。结果共纳入67例患者,萘莫司他组31例,枸橼酸钠组36例。两组一般资料差异无统计学意义(P>0.05)。萘莫司他组在接受CRRT治疗24 h后IL-6数值明显低于枸橼酸钠组(Z=-3.282,P<0.05)。萘莫司他组存活患者治疗后PCT数值下降至正常范围所需要的时间明显少于枸橼酸钠组[(10.16±1.55)d vs.(12.55±2.26)d,P<0.05]。Kaplan-Meier生存分析显示,萘莫司他组患者住院28 d生存率明显高于枸橼酸钠组(P<0.05),而两组间患者7 d、14 d以及21 d住院生存率差异无统计学意义(P>0.05)。两组CRRT治疗后第一套滤器在72 h内生存寿命之间差异无统计学意义[(49.81±3.45)h vs.(45.36±2.83)h,P>0.05],且两组间使用总滤器套数及滤器使用时间之间差异无统计学意义(P>0.05)。结论对比枸橼酸钠,萘莫司他可有效清除患者的炎性介质,在脓毒症患者中疗效更佳,可显著改善该类患者的生存预后,但两种抗凝剂对滤器寿命的影响无显著差异。Objective To evaluate the effects of nafamostat and sodiuml citrate anticoagulant on the survival rate and the anticoagulant effectiveness of continuous renal replacement therapy in patients with sepsis.Methods Collect the clinical data of patients suffered from both sepsis and acute kidney injury,who received CRRT and were treated with nafamostat and sodiuml citrate anticoagulant in Tai'an Central Hospital from May 2022 to September 2023.The nafamostat group and sodiuml citrate anticoagulant group were set up to analyze the following indexes:the general situations,the IL-6 of 24 hours after CRRT treatment,the time it takes for the PCT to fall into the normal range in surviving patients,the 7-day、14-day、21-day and 28-day survival rate,the total quantity and whole time of filter,the the lifespan of the first CRRT filter in 72 hours by retrospective analysis.Results Our study involved the total of 67 patients,of which 31 were divided into nafamostat group and 36 were divided into sodiuml citrate anticoagulant group.There was no significant difference in general information between the two groups(P>0.05).The IL-6 of nafamostat group was significantly lower than that of insodiuml citrate anticoagulant group after 24 hours of CRRT(Z=-3.282,P<0.05).The time required for PCT to decline to the normal range after treatment was significantly shorter in the nafamostat group than in the sodium citrate anticoagulant group[(10.16±1.55)d vs.(12.55±2.26)d,P<0.05].Kaplan-Meier survival analysis showed that the 28-day survival rate of patients in the nafamostat group was significantly higher than that in the sodiuml citrate anticoagulant group(P<0.05),nevertheless no significant difference existed between the 7-day、14-day and 21-day survival rate.There was no significant difference in the first filter life of CRRT between the two groups[(49.81±3.45)h vs.(45.36±2.83)h,P>0.05],and also no significant difference were found in the total quantity and the whole time of the filter(P>0.05).Conclusion When sepsis was integrated w

关 键 词：甲磺酸萘莫司他 枸橼酸钠抗凝剂 脓毒症急性肾损伤 生存率 

分 类 号：R459.7[医药卫生—急诊医学]