甲磺酸萘莫司他抗凝对外科重症监护病房患者连续性肾脏替代治疗有效性及安全性回顾性研究

A retrospective study on the efficacy and safety of nafamostat mesilate anticoagulation for patients treated with continuous renal replacement therapy in surgery intensive care unit

目的通过回顾性研究评估甲磺酸萘莫司他抗凝用于外科重症监护病房(surgery intensive care unit,SICU)患者连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)的有效性及安全性。方法收集2021年1月至2022年3月收治于上海交通大学附属新华医院麻醉与重症医学科并行CRRT治疗、使用甲磺酸萘莫司他进行体外回路抗凝治疗(抗凝组)及无肝素透析方案的患者(无肝素组)。分析两组接受CRRT时过滤器使用寿命、过滤器更换率及体外回路血栓的发生率,比较抗凝组接受CRRT前后弥散性血管内凝血(disseminated intravascular coagulation,DIC)指标、血小板计数、血红蛋白水平、电解质及是否发生消化道出血、血尿、脑出血等出血情况,同时关注住院费用等经济学指标。结果共回顾性纳入14例患者使用甲磺酸萘莫司他抗凝方案,共完成53次CRRT治疗;19例使用无肝素抗凝方案,共完成67次CRRT。抗凝组接受CRRT过程中过滤器及管路凝血更换率低于无肝素组(5.66%vs 17.91%,P<0.05),过滤器平均使用时间长于无肝素组[(10.31±2.65)h vs(7.28±1.87)h,P<0.05]。甲磺酸萘莫司他抗凝对接受CRRT前后的DIC指标、血小板计数无影响(P>0.05)。抗凝组接受CRRT过程中未发生高钾血症,血钾较治疗前差异有统计学意义(P<0.05),血钠、血氯差异无统计学意义(P>0.05)。结论SICU患者接受CRRT治疗时,使用甲磺酸萘莫司他抗凝安全、有效。

Objective To evaluate the efficacy and safety of nafamostat mesilate anticoagulation in patients treated with continuous renal replacement therapy(CRRT)in surgery intensive care unit(SICU)by retrospective study.Methods From January 2021 to March 2022,patients who were admitted to the department of anesthesia and critical care medicine,Xinhua hospital affiliated to Shanghai Jiao Tong university and treated with CRRT,with nafamostat mesilate(anticoagulation group)and no heparin dialysis regimen(no heparin group)were enrolled.The filter life,filter replacement rate and the incidence of extracorporeal circuit thrombosis were analyzed.The disseminated intravascular coagulation(DIC)index,platelet count,hemoglobin level,electrolytes,the occurrence of gastrointestinal bleeding,hematuria,cerebral hemorrhage and other bleeding conditions before and after CRRT in the anticoagulation group was compared,and pay attention to the cost of hospitalization and other economic indicators.Results A total of 53 CRRT treatments were completed in 14 patients treated with nafamostat mesilate.A total of 67 CRRT treatments were completed in 19 patients with heparin-free anticoagulation regimen.The coagulation change rate of the filter and pipeline in the anticoagulation group was lower than that in the no heparin group(5.66%vs 17.91%,P<0.05),and the average use time of the filter was longer than that in the non-heparin group[(10.31±2.65)h vs(7.28±1.87)h,P<0.05].The DIC index and platelet count before and after CRRT were not affected by nafamostat mesilate anticoagulation(P>0.05).In the anticoagulant group,hyperkalemia did not occur during CRRT,and the difference in serum potassium was statistically significant compared with that before treatment(P<0.05),while the difference in serum sodium and serum chloride was not statistically significant(P>0.05).Conclusion Nafamostat mesilate is a safe and effective anticoagulant for patients treated with CRRT in SICU.