| 摘要: |
| ［摘要］ 目的 观察甲磺酸萘莫司他（NM）在高出血风险患者连续性血液净化（CBP）中的抗凝应用效果。方法 回顾性收集2023年1月至3月广西壮族自治区人民医院重症医学科收治的34例需要进行CBP的有高出血风险重症患者的临床资料，根据抗凝剂使用情况将其分为NM组（10例）、枸橼酸钠组（10例）和低分子量肝素组（14例）。比较三组滤器寿命以及临床显著出血事件和其他不良事件发生情况。结果 NM组、枸橼酸钠组和低分子量肝素组的滤器寿命分别为40.00（17.00，51.00）h、36.00（22.00，60.00）h和51.00（45.00，61.50）h，三组比较差异无统计学意义（H=2.096，P=0.351）。在抗凝过程中，NM组无临床显著出血事件发生，枸橼酸钠组和低分子量肝素组分别有3例（30.00%）和4例（28.57%）患者发生临床显著出血事件，三组临床显著出血事件发生率比较差异有统计学意义（χ2=14.171，P=0.001）。低分子量肝素组发生继发性血小板减少6例。NM组未发生过敏反应、高钾血症和粒细胞缺乏症等NM输注相关的不良反应。枸橼酸钠组未发生枸橼酸钠蓄积、枸橼酸钠中毒等不良反应。三组患者均未观察到血栓栓塞事件。结论 NM的抗凝效果与枸橼酸钠、低分子量肝素抗凝效果相当，且临床显著出血事件发生率更低，在高出血风险患者中应用的安全性良好。 |
| 关键词: 甲磺酸萘莫司他 枸橼酸钠抗凝剂 低分子量肝素 连续性血液净化 滤器寿命 出血 |
| DOI：10.3969/j.issn.1674-3806.2024.01.13 |
| 分类号: |
| 基金项目:广西医疗卫生适宜技术开发与推广应用项目（编号：S2022016）；广西壮族自治区卫生健康委员会自筹经费科研课题（编号：Z-A20220174）；广西科技基地和人才专项（编号：桂科AD22035101） |
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| Observation on the anticoagulant application effect of nafamostat mesilate on continuous blood purification in patients with high bleeding risk |
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LU Wenting1, XIANG Shulin1,2, REN Yanwen1, HU Kunlin1, PANG Jing1, MO Li1, XIONG Bin1,2
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1.Department of Critical Care Medicine, the People′s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences), Nanning 530021, China; 2.Research Center of Communicable and Severe Diseases, the People′s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences), Nanning 530021, China
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| Abstract: |
| ［Abstract］ Objective To observe the anticoagulant application effect of nafamostat mesilate(NM) on continuous blood purification(CBP) in patients with high bleeding risk. Methods The clinical data of 34 critically ill patients with high bleeding risk who needed CBP treatment in the Department of Critical Care Medicine of the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2023 to March 2023 were retrospectively collected. The patients were divided into NM group(10 cases), sodium citrate group(10 cases) and low molecular weight heparin group(14 cases) according to the use of anticoagulants. The filter service life and the occurrence of clinically significant bleeding events and other adverse events were compared among the three groups. Results The filter service life was 40.00(17.00, 51.00)hours, 36.00(22.00,60.00) hours and 51.00(45.00,61.50)hours in the NM group, the sodium citrate group and the low molecular weight heparin group, respectively, and there was no significant difference among the three groups(H=2.096, P=0.351). During the anticoagulation process, there were no clinically significant bleeding events in the NM group, while there were 3 cases(30.00%) and 4 cases(28.57%) of clinically significant bleeding events in the sodium citrate group and the low molecular weight heparin group, respectively. The difference in the incidence of clinically significant bleeding events among the three groups was statistically significant(χ2=14.171, P=0.001). Six cases of secondary thrombocytopenia occurred in the low molecular weight heparin group. The adverse reactions related to NM infusion, such as allergic reactions, hyperkalemia and agranulocytosis did not occur in the NM group. There were no adverse reactions such as accumulation of citric acid and citric acidosis in the sodium citrate group. Thromboembolic events were not observed in the patients in the three groups. Conclusion The anticoagulant effect of NM is comparable to that of sodium citrate and low molecular weight heparin, and the incidence of clinically significant bleeding events of NM is lower, so the safety of application of NM in the patients with high bleeding risk is good. |
| Key words: Nafamostat mesilate(NM) Sodium citrate anticoagulant Low molecular weight heparin Continuous blood purification(CBP) Filter service life Hemorrhage |
