甲磺酸萘莫司他抗凝在心血管外科术后高危出血风险患者连续性肾脏替代治疗中应用

Effects of nafamostat mesilate anticoagulant on continuous renal replacement therapy in patients at high risk of bleeding after cardiovascular surgery

目的 探讨心血管外科术后高危出血风险患者接受连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)时使用甲磺酸萘莫司他作为抗凝剂的应用效果。方法 纳入海军军医大学第一附属医院心血管外科2021年8月至2022年4月的心血管外科术后需接受CRRT且存在高危出血风险的患者27例,根据患者接受CRRT时抗凝剂的不同,将其分为抗凝组(甲磺酸萘莫司他作为抗凝剂,n=12)和无抗凝组(n=15),对比两组治疗期间不良事件发生率及滤器使用寿命等,并进一步对照分析抗凝组治疗期间凝血指标等。结果 抗凝组第一套管路体外循环寿命明显长于无抗凝组[(31.82±10.84)h vs(21.64±12.26)h,P=0.033],CRRT期间的滤器平均使用寿命亦明显长于无抗凝组(P <0.05),且整个治疗期间未发生出血等不良事件。结论 在心血管外科术后高出血风险患者CRRT过程中,使用甲磺酸萘莫司他作为抗凝剂安全且有效,能有效延长滤器使用时间,且在整个治疗期间并未增加出血事件的发生风险。

Objective To investigate the effects of nafamostat mesilate as an anticoagulant in patients at high risk of bleeding after cardiovascular surgery undergoing continuous renal replacement therapy(CRRT).Methods Twenty-seven patients with high risk of bleeding who underwent CRRT after cardiovascular surgery in the first affiliated hospital of naval medical university from August 2021 to April 2022 were enrolled.According to the different anticoagulants,the patients were divided into anticoagulant group(nafamostat mesilate as anticoagulant,n=12) and non-anticoagulant group(n=15).The incidence of adverse events and the service life of the filter were compared between the two groups,and the coagulation indexes of the anticoagulation group during the treatment were further analyzed.Results The life of cardiopulmonary bypass through the first cannula was significantly longer than that in the non-anticoagulation group[(31.82±10.84)h vs (21.64±12.26)h,P=0.033].The average service life of the filter during CRRT were also significantly longer than those in the non-anticoagulation group(P<0.05),Also,the incidence of bleeding events in the anticoagulation group was no increase throughout the treatment period.Conclusion It is safe and effective to use nafamostat mesilate as an anticoagulant in patients with high bleed risk after cardiovascular surgery during CRRT,which can effectively prolong the use time of the filter and no increase in the incidence of hemorrhagic complications.