阿加曲班在床旁血液滤过治疗中的疗效观察

Therapeutic effect of argatroban in patients under hemofiltration treatments

目的:对比分析阿加曲班与低分子肝素钠在床旁血液滤过治疗中的抗凝效果及安全性。方法:将154例行床旁血液滤过患者随机分为两组:56例患者采取阿加曲班抗凝治疗(阿加曲班组);98例患者采取低分子肝素钠抗凝治疗(低分子肝素组)。对比两组患者治疗前、第一次和第五次疗程结束后活化凝血酶原时间(APTT)、血红蛋白水平(Hb)、血小板计数(PLT),以滤器跨膜压、滤器残余血量、滤器使用寿命作为抗凝效果的观察指标,结合出血风险作为抗凝安全性的观察指标。结果:治疗前,阿加曲班组患者的APTT水平高于低分子肝素组,Hb、PLT水平低于低分子肝素组;两组数据具有显著性差异(P<0.05);第一次和第五次疗程结束后,阿加曲班组患者的APTT、Hb、PLT水平均无显著性改变(P>0.05),低分子肝素组患者的Hb水平无显著性改变(P>0.05),而APTT水平升高,PLT水平降低,均具有显著性改变(P<0.05);第一次疗程结束后,两组患者的滤器跨膜压、滤器残余血量、滤器使用寿命均无显著性差异(P>0.05);透析抗凝治疗期间,两组患者均无明显出血倾向,出血风险无显著性差异(P>0.05)。结论:在床旁血液滤过治疗时使用阿加曲班的抗凝效果与低分子肝素钠相当,安全性高,具有明确的监测指标,可作为理想的抗凝剂,具有良好的临床应用前景。

Objective： To observe the effects and safty of argatroban and low molecular weight heparin in patients with intermittent bedside hemofiltration treatment, and assess the feasibility of argatroban as an anticoagulant.Methodology： From January 2014 to December 2014,one hundred and fifty four patients received routine intermittent bedside hemofiltration were selected into this study. They were randomly divided into two groups： 56 patients were taken argatroban anticoagulation as argatroban group; and 98 patients were recieved low molecular weight heparin anticoagulant therapy as a low molecular weight heparin group. The activated prothrombin time（ APTT）,hemoglobin（ Hb）,platelet count（ PLT）,transmembrane pressure in the filter,the filter of residual blood,the life of the filter as the anticoagulant effect observed indicators were compared between two groups of patients before treatment,for the first time after the end of the fifth course and,the risk of bleeding as outcome measures of anticoagulation security was also compared. Results：Before treatment,the levels of APTT in argatroban group were higher than that in LMWH group,while the levels of Hb,and PLT were lower than that in low molecular weight heparin group; two sets of data had significant differences（ P〈0. 05）. The first and fifth after the second course of treatment,the levels of APTT,Hb,and PLT level were no significant change in patients with argatroban（ P〉0. 05）. In patients with low molecular weight heparin,the level of Hb was no significant change（ P〉0. 05）,while the level of APTT was increased,and PLT was decreased significantly（ P〈0. 05）.After the first treatment,filters transmembrane pressure between the two groups,the residual blood filter,the filter life was no significant difference（ P〉0. 05）; anticoagulant during dialysis treatment,both groups of patients had no significant bleeding tendency,bleeding was no significant difference（ P〉0. 05）. Conclusion： Argatroban as similar to lowmolecular weight heparin is efficiency and safety to be used in patients with intermittent bedside hemofiltration treatment.