萘莫司他在有出血风险患者连续性肾脏替代治疗中的效果  

Effect of nafamostat in continuous renal replacement therapy for patients at risk of bleeding

作　　者：汤小芳 章旭 蒋春明[1] 章喜俊 唐澎 李康峰 TANG Xiaofang;ZHANG Xu;JIANG Chunming;ZHANG Xijun;TANG Peng;LI Kangfeng(Department of Nephrology,Taikang Xianlin Drum Tower Hospital,Afiliated Hospital of Medicine School of Nanjing University,Nanjing,Jiangsu 210046,China;不详)

机构地区：[1]南京大学医学院附属泰康仙林鼓楼医院肾内科,江苏南京210046 [2]南京江北医院肾内科,江苏南京210048

出　　处：《中国临床研究》2025年第4期588-592,共5页Chinese Journal of Clinical Research

基　　金：江苏省科技计划项目(YKK18275)。

摘　　要：目的 比较肝素-鱼精蛋白中和、局部枸橼酸钠及甲磺酸萘莫司他运用于出血风险患者连续性肾脏替代治疗(CRRT)的效果。方法 回顾性选择南京大学医学院附属泰康仙林鼓楼医院肾内科及南京江北医院肾内科自2018年1月至2024年1月65例终末期肾脏病(ESRD)患者为研究对象,患者皆因活动性出血或伴有出血倾向以肝素-鱼精蛋白中和或局部枸橼酸抗凝或持续萘莫司他泵入行日间CRRT。根据抗凝方案将65例ESRD患者分为3组,采用肝素-鱼精蛋白中和抗凝的22例患者为A组,采用局部枸橼酸抗凝的22例患者为B组,采用持续萘莫司他泵入的21例患者为C组。记录3组患者治疗前后电解质、肝功能、血肌酐、动脉血气、部分活化凝血活酶时间(APTT)、血小板计数以及滤器后Ca^(2+)变化,并观察3组滤器及管路凝血情况,计算补碱量。结果 3组血小板计数、丙氨酸氨基转移酶、胆红素比较差异无统计学意义(P>0.05)。3组治疗后血肌酐均显著降低(P<0.05),且达到日间CRRT临床要求。3组APTT比较差异有统计学意义(P<0.05),C组治疗后APTT均较治疗前延长(P<0.05)。结论 三种不同抗凝方式用于有出血风险患者的CRRT,相对于肝素-鱼精蛋白中和、局部枸橼酸钠方法,萘莫司他持续泵入抗凝方法操作简单,并发症较少。Objective To compare the effectiveness of heparin-protamine neutralization,or local citrate anticoagulation,and continuous infusion of nafamostat in continuous renal replacement therapy(CRRT)for patients at risk of bleeding.Methods A retrospective study was conducted on 65 patients with end-stage renal disease(ESRD)who received CRRT due to active bleeding or a tendency to bleed,from January 2018 to January 2024 at the Department of Nephrology,Taikang Xianlin Drum Tower Hospital and Nanjing Jiangbei Hospital.All patients received daytime CRRT with heparin-protamine neutralization,or local citrate anticoagulation,or continuous infusion of nafamostat.According to the anticoagulation regimen,the 65 ESRD patients were divided into three groups:22 patients in group A received heparin-protamine neutralization,22 patients in group B received local citrate anticoagulation,and 21 patients in group C received continuous infusion of nafamostat.Pre-and post-treatment electrolyte levels,liver function,blood creatinine,arterial blood gas,activated partial thromboplastin time(APTT),platelet count,and post-filter calcium ion changes were recorded.The occurrence of clotting in the filter and tubing was observed,and the base correction dose was calculated.Results There was no statistically significant difference in platelet count,alanine aminotransferase(ALT),and bilirubin levels among the three groups(P>0.05).Post-treatment blood creatinine levels were significantly reduced in all three groups(P<0.05),meeting the clinical requirements for daytime CRRT.There were statistically significant differences in APTT among the three groups(P<0.05).In group C,APTT was prolonged post-treatment compared to pre-treatment(P<0.05).Conclusion The use of three different anticoagulation methods in CRRT for patients at risk of bleeding shows that continuous infusion of nafamostat is simpler to operate,and results in fewer complications compared to heparin-protamine neutralization and local citrate anticoagulation.

关 键 词：连续性肾脏替代治疗 甲磺酸萘莫司他 出血风险 抗凝 肝素 鱼精蛋白 枸橼酸钠 

分 类 号：R459.5[医药卫生—治疗学]