甲磺酸萘莫司他体外抗凝在血液透析高危出血风险患者中的应用观察  

Observation of extracorporal administration of the anticoagulant nafamostat mesylate in hemodialysis patients with high bleeding risk

作　　者：杨振华[1] 陈秋馨 李倩玉 潘孝婷 王璐[1] 陈瑜[1] 陈晓农[1] 马晓波[1] YANG Zhen-hua;CHEN Qiu-xin;LI Qian-yu;PAN Xiao-ting;WANG Lu;CHEN Yu;CHEN Xiao-nong;MA Xiao-bo(Hemodialysis Center,Department of Nephrology,Shanghai Ruijin Hospital Affiliate to Shanghai Jiaotong University School of Medicine,Shanghai,200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院肾脏内科血液净化中心,上海200025

出　　处：《中国血液净化》2024年第9期651-654,662,共5页Chinese Journal of Blood Purification

基　　金：上海市临床重点专科建设项目(shslczdzk02502)。

摘　　要：目的 探讨血液透析(hemodialysis,HD)高危出血患者行HD治疗时使用甲磺酸萘莫司他(nafamostatmesylate,NM)的安全性和有效性。方法 纳入2023年1月─2023年8月上海交通大学医学院附属瑞金医院行HD治疗存在高危出血风险的患者60例,随机化分为NM抗凝组(抗凝组)和无抗凝剂组(无抗凝组)各30例。比较2组HD治疗的有效性和安全性。结果 抗凝组体外循环管路使用时间更长(t=5.118,P<0.001)、透析器平均使用寿命更长(t=4.691,P<0.001)、静脉压报警干预次数更少(χ^(2)=4.691,P<0.010)、0~I级抗凝有效率更高(χ^(2)=24.300,P<0.001)、单室模型尿素清除指数(spKt/V)更高(t=17.456,P<0.010);抗凝组跨膜压报警干预次数及透析器更换次数均为0次。抗凝组透析管路肝素泵前的血液管路(A采血点)检测的HD治疗前、治疗1h、2h、3h、治疗结束时以及透析结束后15min位于自体动静脉内瘘对侧肢体(C采血点)检测的活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT)、国际标准化比值(INR)、纤维蛋白原(Fg)、纤维蛋白降解产物(FDP)无统计学差异(F=0.132、1.708、0.025、1.394、0.849、0.993,P=0.985、0.135、1.000、0.229、1.106、0.424);位于透析器后的血液管路(B采血点)检测的活化凝血时间(ACT)在HD治疗1h、2h、3h、结束时变化无统计学差异(F=0.297,P=0.914)。2组均未发生过敏反应、高血钾、出血、心律失常等不良事件。结论 NM作为血液透析高危出血风险患者的抗凝剂,具有良好的有效性和安全性。Objective To investigate the safety and efficacy of nafamostat mesylate in hemodialysis(HD)patients with high bleeding risk.Methods A total of 60 patients with high bleeding risk undergoing HD treated in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2023 to August 2023 were randomly divided into anticoagulant group(nafamostat mesylate group)and no anticoagulant group,with 30 cases in each group.The efficacy and safety of HD were compared between the two groups.Results In the anticoagulant group,the use time of cardiopulmonary bypass pipeline was longer(t=5.118,P<0.001),the average service life of dialyzer was longer(t=4.691,P<0.001),the number of venous pressure alarm intervention was less(χ^(2)=4.691,P<0.010),the effective rate of grade 0-1 anticoagulation was higher(χ^(2)=24.300,P<0.001),the single chamber model urea clearance index(spkt/v)was higher(t=17.456,P<0.010),and no transmembrane pressure alarm intervention and dialyzer replacement happened.In the anticoagulant group,the activated partial thromboplastin time(APTT),thrombin time(TT),prothrombin time(PT),international normalized ratio(INR),fibrinogen(FG)and fibrin degradation products(FDP)had no significant differences in the samples from blood pipeline before heparin pump(blood collection point A)before HD,during HD at 1h,2h,3h,and end of HD,and in the sample from contralateral limb without autologous arteriovenous fistula(blood collection point C)after HD for 15min(F=0.132,1.708,0.025,1.394,0.849 and 0.993 respectively;P=0.985,0.135,1.000,0.229,1.106 and 0.424 respectively).The activated clotting time(ACT)showed no significant difference in the samples from the blood pipeline behind the dialyzer(blood collection point B)during HD at 1h,2h,3h,and end of HD(F=0.297,P=0.914).No adverse events including allergic reaction,hyperkalemia,bleeding,arrhythmia occurred in the two groups.Conclusion Nafamostat mesylate has better efficacy and safety used as an anticoagulant for HD in patients with high bleeding risk.

关 键 词：血液透析 甲磺酸萘莫司他 抗凝 

分 类 号：R459.5[医药卫生—治疗学]