目的 比较阿加曲班和枸橼酸钠在连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)中的有效性和安全性。方法 选取2018-09至2019-05医院行CRRT治疗的患者132例,随机分为阿加曲班组60例和枸橼酸钠组72例,分别给予阿加曲班和枸橼酸钠抗凝治疗,阿加曲班组监测体内活化凝血时间(activated clotting time,ACT),枸橼酸钠监测ACT及血钙,同时记录两组患者透析前后血常规、血生化指标,尿素下降率、滤器及管路凝血情况,以及治疗后24 h内组织器官出血情况。结果 两组患者透析前ACT均在正常范围内,阿加曲班组ACT 5 min、2 h和4 h均显著升高,差异有统计学意义(P＜0.05),透析1 h后ACT显著下降至正常范围;枸橼酸钠组透析4 h和透析后ACT均无明显变化。枸橼酸钠组透析前、透析中、透析后体内游离钙均无明显变化;透析中体外游离钙均低于同时间体内游离钙水平。两组患者治疗前后血红蛋白及血小板较治疗前均无明显变化,血肌酐水平均显著下降,差异有统计学意义(P＜0.05)。两组患者治疗时间、URR值、管路滤器凝血情况及出血事件对比差异无统计学意义。结论 阿加曲班和枸橼酸钠在CRRT治疗中均为有效和安全的抗凝剂。对有高出血风险的患者选择枸橼酸钠更佳。
Abstract
Objective To compare the anticoagulant effect and safety of argatroban and sodium citrate in continuous renal replacement therapy (CRRT). Methods A total of 132 patients treated between September 2018 and May 2019 were randomly divided into the argatroban group (n=60) and sodium citrate group (n=72). The two groups were treated with argatroban and sodium citrate as the anticoagulant therapy respectively. The general condition, activated clotting time (ACT),serum calcium, hemoglobin (Hb),platelet count (PLT) and urea reduction rate (URR) were recorded and compared between the two groups. The blood coagulation of filters and pipes during treatment and bleeding events 24 h after treatment were also observed and compared. Results There was no significant difference in general data between the two groups.The ACT was within the normal range before treatment in both groups. In the argatroban group,the ACT was significantly increased 5 min, 2 h and 4 h into the treatment (P<0.05), but significantly reduced to the normal range after 1 hour of treatment. In the sodium citrate group, there was no significant change in the ACT during or after treatment. There was also no significant change in levels of serum calcium before, during and after dialysis in the sodium citrate group.The levels of serum calcium in vitro during dialysis were lower than those in vivo at the same time (P<0.05). There was no significant change in Hb or PLT before and after treatment, and the serum creatinine level was significantly decreased in the two groups (P<0.05). There was no statistically significant difference in the duration of treatment, URR value, coagulation in the pipeline filters and bleeding events between the two groups. Conclusions Argatroban and sodium citrate are effective and safe anticoagulants in the treatment of CRRT. For patients at high risk of bleeding, sodium citrate may be a better choice.
关键词
阿加曲班 /
枸橼酸钠 /
抗凝治疗 /
连续性血液净化 /
肾脏替代治疗
Key words
argatroban /
sodium citrate /
anticoagulant therapy /
continuous blood purification /
renal replacement therapy
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参考文献
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