阿加曲班与低分子肝素在连续性血液净化治疗抗凝中的对比研究

Comparative research on anticoagulative efficacy of argatroban and low molecular weight heparin in continuous blood purification therapy

目的:探讨阿加曲班在连续性血液净化(CBP)治疗抗凝中的疗效及安全性。方法:将30例多器官功能障碍综合征(MODS)患者分成实验组和对照组,每组各15例,在行CBP治疗时,实验组采用阿加曲班注射液抗凝,对照组采用低分子肝素钙抗凝,CBP治疗中监测患者活化部分凝血活酶时间(APTT)、血管路动脉压、静脉压变化;观察管路、滤器凝血情况;观察患者有无组织器官出血等不良反应。结果:阿加曲班组治疗后4h及8h静脉端APTT明显增高,动脉端APTT也增高,但不如静脉端明显,而且治疗后恢复接近治疗前水平。低分子肝素组滤器及或管路凝血发生率26.7%;阿加曲班组滤器及或管路凝血发生率6.7%。阿加曲班组滤器及或管路凝血或器官出血发生率有下降趋势,但无统计学差异(P>0.05)。结论:本研究已观察到阿加曲班的体外抗凝效果有优于低分子肝素的趋势,而很少并发出血,可应用于伴有出血倾向的MODS患者行CBP治疗时的抗凝。

Objective To investigate the anticoagulative efficacy and safety of argatroban in continuous blood purification（CBP） therapy.Methods Thirty patients with multiple organ dysfunction syndrome（MODS） were randomly divided into the experimental group（argatroban group） and the control group（LMWH group）,15 patients in each group.During the CBP therapy, patients in the argatroban group were assigned to receive argatroban injection for anticoagulation, and those in the LMWH group were assigned to receive low molecular weight heparin（LMWH） calcium for anticoagulation.Changes of activated partial thromboplastin time（APTT） and pressure within the pipelines of the arterial and venous ends were monitored during the CBP therapy.Besides, the states of coagulation within the pipeline and filter were observed;and adverse effects such as hemorrhages of tissues or organs of the patients were also observed.Results APTTs of the blood drawn from the pipeline of the venous end were markedly prolonged in the experimental group four and eight hours after the treatment, it also prolonged as of arterial end, but not markedly.They were nearly restored to levels before the treatment.The incidence of coagulation within the filter and / or the pipeline in the LMWH group was 26.7% ,while that in the argatroban group was 6.7%.The incidence of coagulation within the filter and / or the pipeline or that of organic hemorrhages showed downward tendency in the argatroban group, but without statistical difference（P 0.05）.Conclusion This study has revealed that the extracorporeal anticoagulative efficacy of argatroban tends to be better than that of LMWH, and argatroban is very little complicated with hemorrhages.So argatroban could be used for anticoagulation in CBP therapy for those patients who have a hemorrhagic tendency with MODS.