小剂量阿加曲班在连续性血液净化治疗中的应用

Application of small-dose argatroban injection in continuous blood purification

目的探讨小剂量阿加曲班在连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)中的抗凝效果和出血事件。方法给予67例CRRT患者小剂量阿加曲班,首剂0.1μg/kg,微量泵持续追加0.05μg/(kg·min),测定实施治疗前、治疗结束后1 h、结束后2 h及治疗中每2 h凝血功能,采用评分方法评价血滤器凝血和穿刺(置管)处出血及血肿情况。结果血滤器凝血情况治疗前后无明显差异,穿刺(置管)处未见明显出血及血肿,活化部分凝血酶时间(APTT)和血浆凝血酶原时间(PT)治疗后1 h与治疗前有显著差异(P<0.05);治疗后2 h与治疗前无差异。治疗1 h时同时检测动脉端和静脉端PT和APTT值,两者差异有统计学意义(P<0.05)。结论达到治疗抗凝效果时,所需阿加曲班剂量较小,且未发生出血事件,故小剂量阿加曲班用于连续性肾脏替代治疗抗凝效果安全可靠。

Objective To study the anticoagulant effect of and bleeding events with small - dose argatroban injection in continuous renal placement therapy （CRRT）. Methods Sixty- seven patients undergoing continuous renal replacement therapy were continuously given gargatroban injection at the initial dose of 0.1 ug/kg, and then 0.05 ug/（ kg · min） , by a micro pump from the origin of the artery. Patients＇antieoagulant function was examined, and coagulation, bleeding and hematoma around punctures were evaluated before and 1 h after treatment and 2 h after treatment, as well as every 2 h during treatment. Results There was no significant difference in coagulation before and after treatment, and no significant bleeding and hematoma were found around punctures. There was significant differ- ence in the aetivaved partial thromboplastin time （APPT） and prothrombin time （PT） before and 1 h after treatment （P 〈 0.05 ）. No difference was found before and 2 h after treatment. The PT and APTT of the artery and vein examined 1 h after treatment showed significant difference （P 〈 0.05 ）. Conclusions A small dose of argatroban achieves anticoagulant effect and causes no bleeding events. So the anticoagulant effect of using small - dose argatroban is safe and reliable in continuous renal replacement therapy.