肝衰竭患者人工肝治疗中不同抗凝剂的抗凝效果及安全性比较  

Comparison of the anticoagulation effect and safety among different anticoagulants used in artificial liver therapy for patients with liver failure

作　　者：王潇 王建刚[2] 刘新宇[2] WANG Xiao;WANG Jiangang;LIU Xinyu(Department of Internal Medicine,Nanyang Central Hospital,Nanyang 473000,Henan Province,China;Department of Blood Purification,Nanyang Central Hospital,Nanyang 473000,Henan Province,China)

机构地区：[1]南阳市中心医院内科,河南南阳473000 [2]南阳市中心医院血液净化科,河南南阳473000

出　　处：《新乡医学院学报》2025年第4期320-326,共7页Journal of Xinxiang Medical University

基　　金：北京肝胆相照公益基金会资助课题(编号:RGGJJ-2021-021)。

摘　　要：目的探讨枸橼酸钠与肝素钠抗凝对人工肝支持治疗肝衰竭患者抗凝效果及安全性的影响。方法选择2021年10月至2023年10月南阳市中心医院收治的101例行人工肝支持治疗的肝衰竭患者为研究对象,根据抗凝方法不同将患者分为枸橼酸钠组(n=41)和肝素钠组(n=60)。2组患者均给予保肝、抗病毒、维持电解质和酸碱平衡、合理膳食、卧床休息等维持内环境稳定的内科对症支持治疗,结合患者自身情况必要时输注人血白蛋白,同时通过人工肝支持系统给予人工肝支持治疗,枸橼酸钠组患者治疗过程中使用枸橼酸钠进行抗凝,肝素钠组患者治疗过程中使用肝素钠进行抗凝。于治疗前及治疗后24 h采集肘静脉血,检测凝血功能指标[血浆活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)]、肝功能指标[血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、白蛋白(ALB)]以及炎症指标[血浆C-反应蛋白(CRP)、白细胞介素-6(IL-6)、降钙素原(PCT)]水平,并检测单核细胞、中性粒细胞、血小板及淋巴细胞水平,计算单核细胞/淋巴细胞(MLR)、中性粒细胞/淋巴细胞(NLR)、血小板/淋巴细胞(PLR)比值及全身免疫炎症指数(SII);统计患者第1次人工肝治疗开始至随访结束时细菌性腹膜炎、肝肾综合征、消化道出血及肝性脑病发生情况;所有患者至少随访90 d,记录患者随访期间的生存状态、生存时间。结果2组患者治疗前血浆APTT、PT、TT、FIB水平比较差异无统计学意义(P>0.05)。2组患者治疗后24 h血浆APTT、PT、TT、FIB水平与治疗前比较均显著降低(P<0.05)。治疗后24 h,枸橼酸钠组患者血浆APTT、PT、TT水平显著低于肝素钠组(P<0.05),2组患者血浆FIB水平比较差异无统计学意义(P>0.05)。2组患者治疗前血清AST、ALT、DBIL、TBIL、IBIL及ALObjective To investigate the anticoagulation effect and safety of sodium citrate and sodium heparin in artificial liver support therapy for patients with liver failure.Methods A total of 101 patients with liver failure who received artificial liver support therapy at Nanyang Central Hospital from October 2021 to October 2023 were selected as study subjects.According to different anticoagulation methods,the patients were divided into a sodium citrate group(n=41)and a heparin sodium group(n=60).Both groups of patients received symptomatic supportive medical treatment to keep internal environment stability,including liver protection,antiviral therapy,maintaining electrolyte and acid-base balance,a reasonable diet,and bed rest.Human serum albumin(ALB)was infused when necessary based on the patient's condition.At the same time,artificial liver support therapy was offered through the artificial liver support system.During the treatment process,the sodium citrate and heparin sodium groups adopted sodium citrate and heparin sodium for anticoagulation,respectively.Elbow venous blood was collected before treatment and 24 hours after treatment to measure coagulation function indicators[including activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),and fibrinogen(FIB)],liver function indicators[including serum alanine amino-transferase(ALT),aspartate amino-transferase(AST),total bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),and ALB],and inflammatory indicators[including plasma C-reactive protein(CRP),interleukin-6(IL-6),and procalcitonin(PCT)].The levels of monocytes,neutrophils,platelets,and lymphocytes were also measured,and the monocyte-to-lymphocyte ratio(MLR),neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and systemic immune-inflammation index(SII)were calculated.The occurrence of bacterial peritonitis,hepatorenal syndrome,gastrointestinal bleeding,and hepatic encephalopathy in the patients from the start of the first artificial liver treatment to th

关 键 词：肝衰竭 人工肝 肝素钠抗凝 枸橼酸钠抗凝 

分 类 号：R575.3[医药卫生—消化系统]