阿加曲班与低分子肝素钠在床旁血液滤过治疗中的疗效观察

The Curative Effect Observation of Argatroban and Low Molecular Heparin Sodium in the Treatment of Bedside Hemofiltration

本研究旨在探讨阿加曲班在床旁血液滤过治疗中的抗凝效果及安全性。选取2015年8月~2016年8月在我院行床旁血液滤过治疗的166例患者,其中采用阿加曲班进行抗凝治疗的患者62例作为观察组,采用低分子肝素钠进行抗凝治疗的患者104例作为对照组。分别于治疗前、第1次、第5次治疗结束后检测两组患者的血红蛋白(Hb)、血小板计数(PLT)及凝血酶原时间(APTT);抗凝效果观察指标包括:滤器残余血量、滤器跨膜压、滤器使用寿命,并同时观察对比两组的出血风险。本研究结果显示:治疗前观察组患者的血浆APTT、Hb、PLT水平比较差异无统计学意义(p<0.05);第1次和第5次治疗结束后,两组患者的血浆APTT水平均较治疗前明显升高,血浆Hb、PLT水平明显降低,差异具有统计学意义(p<0.05)。第5次治疗后和第1次治疗后比较,观察组患者的血浆APTT、Hb、PLT水平比较差异无统计学意义(p>0.05);而对照组患者血浆APTT水平明显升高,PLT水平较治疗前明显降低,差异具有统计学意义(p>0.05)。治疗结束后两组患者的滤器残余血量、滤器跨膜压、滤器使用寿命比较差异无统计学意义(p>0.05),两组均无明显的出血事件发生。本研究认为床旁血液滤过治疗时采用阿加曲班进行抗凝治疗,抗凝效果及安全性良好,尤其适用于有出血风险的患者。

The purpose o f this study was to investigate the anticoagulant effect and safety of argatroban in the treatment of bedside hemofiltration. We selected 166 cases of patients who were received bedside hemofiltration treatment in our hospital from August 2015 to August 2016, among which 62 cases of patients who received argatroban for anticoagulant therapy formed the observation group, and 104 cases of patients who received low molecular weight heparin sodium for anticoagulant therapy formed the control group. We detected the hemoglobin （Hb）, platelet count （PLT） and activated partial thromboplastin time （APTT） of two groups before the treatment, the first and fifth time after treatment, respectively; the observation indexes of anticoagulant effect included the residual blood, transmembrane pressure and service life of the filter, meanwhile we observed and compared the bleeding risk of two groups. The results showed that the level of plasma APTT, Hb, PLT of the observation group before treatment had no statistically significant difference （P〈0.05）; after the first and fifth treatment, the plasma APTT of two groups both were higher than those before the treatment, but the Hb and PLT levels of two groups were lower, and the difference was statistically significant （p〈0.05）; compared with the first treatment, the level of plasma APTT, Hb, PLT of the observation group after fifth treatment had no statistically significant difference （p〉0.05）. However, the level of plasma APTT of the control group increased significantly, but PLT decreased and the difference was statistically significant （p〉0.05）. After the treatment, we compared the residual blood, transmembrane pressure and service life of the filter of two groups and found that the difference had no statistical significance （p〉0.05）, and there was no significant bleeding events occurred in two groups. The conclusion of this study indicated that the anticoagulation efficacy and safety of argatroban in bedside hemofiltration treatment were quite good, which was especially suitable for patients with bleeding risk.