普通肝素与萘莫司他抗凝方案对肝衰竭人工肝治疗的抗凝效果与安全性分析  

Comparison and Safety Analysis of Anticoagulant Effect between Ordinary Heparin and Nafamostat Anticoagulant Regimen in Artificial Liver Treatment of Liver Failure

作　　者：柳盛 周永 董晓坤 王朝辉 LIU Sheng;ZHOU Yong;DONG Xiaokun;WANG Zhaohui(Department of Blood Purification,Qingdao Sixth People’s Hospital,Qingdao 266033,China;Department of Gastroenterology,Qingdao Sixth People’s Hospital,Qingdao 266033,China;Hepatology Department 2,Qingdao Sixth People’s Hospital,Qingdao 266033,China)

机构地区：[1]青岛市第六人民医院血液净化科,青岛266033 [2]青岛市第六人民医院消化内二科,青岛266033 [3]青岛市第六人民医院肝病二科,青岛266033

出　　处：《宁夏医科大学学报》2024年第8期824-829,共6页Journal of Ningxia Medical University

基　　金：北京肝胆相照基金会人工肝专项基金项目(iGandanF-1082023-RGG019)。

摘　　要：目的 探究肝衰竭人工肝治疗中萘莫司他抗凝方案的临床疗效和安全性,并与普通肝素抗凝方案进行比较,从而为提高人工肝治疗抗凝疗效提供理论依据。方法 选取2022年1月至2023年12月青岛市第六人民医院收治的80例肝衰竭患者,均进行人工肝治疗。其中,选取40例患者为观察组,应用甲磺酸萘莫司他抗凝方案;40例为对照组,应用普通肝素抗凝方案。比较两组患者的抗凝效果(凝血分级)、凝血功能变化[体内外活化凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、血小板(PLT)、凝血国际标准化比值(INR)]、肝功能指标变化[总胆红素(TBIL)、谷丙转氨酶(ALT)、白蛋白(ALB)血常规等生化指标]和不良反应发生情况[出血、低血压、过敏反应、新增不适症状]。结果 在抗凝效果方面,两组患者的凝血分级整体比例差异无统计学意义(P>0.05)。在凝血功能方面,治疗前后两组患者的PT比较,差异无统计学意义(P>0.05);治疗后两组患者的PLT均较治疗前减少(P均<0.05),且观察组PLT水平高于对照组(P<0.05);治疗后两组患者的INR均较治疗前减少(P均<0.05);治疗后观察组的体内APTT无延长,而体外APTT延长(P<0.05),对照组患者的体内、体外APTT均显著延长(P均<0.05)。在肝功能指标方面,治疗前两组患者的肝功能指标差异无统计学意义(P>0.05),治疗后观察组的TBIL水平低于对照组(P<0.05),而ALB和ALT水平两组治疗后差异无统计学意义(P<0.05)。此外,两组患者的不良反应发生率差异无统计学意义(P>0.05)。结论 相比普通肝素来说,萘莫司他作为肝衰竭人工肝治疗患者的抗凝方案具有良好的抗凝效果,且具有良好的安全性。Objective To explore the clinical efficacy and safety of nafamostat anticoagulant regimen in artificial liver treatment for liver failure,and to compare it with ordinary heparin anticoagulant regimen,to provide a theoretical basis for improving the anticoagulant effect of artificial liver therapy.Methods A total of 80 patients with liver failure were admitted to Qingdao Sixth People’s Hospital from January 2022 to December 2023 and were treated with artificial liver therapy,among which,40 patients were selected as observation groups and were treated with nafamostat anticoagulant regimen,and 40 patients as the control group were treated with an ordinary heparin anticoagulant regimen.The anticoagulant effec(t coagulation grade),changes in coagulation function[in vivo and in vitro activated thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),platele(t PLT),international normalized ratio of coagulation(INR)],changes in liver function indexes[total bilirubin(TBIL),alanine aminotransferase(ALT),albumin(ALB)blood routine,and other biochemical indexes]were compared between the two groups and the occurrence of adverse reactions,adverse reactions mainly statistical bleeding,chills,urticaria,fever and so on.Results In terms of comparing anticoagulant effects,there was no statistically significant difference in the overall proportion of coagulation grades between the two groups of patients(P>0.05).There were no statistically significant difference in PT between the two groups of patients before and after treatment(P>0.05).After treatment,the PLT of both groups of patients decreased compared to before treatmen(t P all<0.05),and the PLT level in the observation group was higher than that in the control group(P<0.05).After treatment,the INR of both groups of patients decreased compared to before treatment(P all<0.05),and the in vivo APTT of the observation group was not significantly prolonged.And the in vitro APTT was significantly prolonged(P<0.05),while the in vivo and in vitro APTT of the control group patien

关 键 词：肝衰竭 人工肝治疗 普通肝素 萘莫司他 抗凝效果 安全性 

分 类 号：R575.3[医药卫生—消化系统]