血液透析中甲磺酸萘莫司他抗凝的血药浓度与抗凝有效性观察

Observation on the anticoagulant efficacy and blood concentration of nafamostat mesylate in hemodialysis

目的探讨甲磺酸萘莫司他(nafamostat mesylate,NM)在血液透析中作为抗凝剂的安全性和有效性,以及其对维持性血液透析患者全身凝血功能的影响。方法前瞻性分析2022年1月—9月于成都市第一人民医院肾脏内科接受治疗的12名维持性血液透析患者,分别采集透析上机前(动脉端),透析中(透析1h、2h、3h、4h)滤器前、滤器后、动脉端,透析后15min(动脉端)的血液标本,测定NM的血药浓度及活化凝血时间(activated clotting time,ACT)。结果在透析中1h、2h、3h、4h,相同时间点监测ACT提示滤器前、滤器后、动脉端有统计学差异(F值分别为21.899,27.464,8.264,8.162;P值分别为<0.001,<0.001,0.001,0.001),相同时间点两两比较均表现为动脉端最低,滤器前ACT较动脉端升高,滤器后ACT较滤器前降低;在透析中1h、2h、3h、4h,相同时间点监测NM血药浓度提示滤器前、滤器后、动脉端有统计学差异(F值分别为46.547,20.059,16.582,16.687;P值分别为<0.001,<0.001,<0.001,<0.001),相同时间点两两比较均表现为动脉端NM血药浓度较其余监测点低,滤器前NM血药浓度较动脉端升高,滤器后NM血药浓度较滤器前降低。结论甲磺酸萘莫司他在血液透析体外循环中能有效发挥抗凝作用,其具备高透析清除率和快速体内代谢的特性,对全身凝血状态的影响较小,可作为高危出血风险患者血液透析时抗凝剂的新选择。

Objective To explore the safety and effectiveness of nafamostat mesylate(NM)as an anticoagulant for hemodialysis,and its impact on the systemic coagulation function in patients undergoing maintenance hemodialysis(MHD).Methods A prospective study was conducted on 12 MHD patients at the Department of Nephrology,The First People's Hospital of Chengdu from January to September 2022.Blood samples were collected at various time points:before dialysis at the arterial end,during dialysis(1h,2h,3h and 4h)and 15 minutes post-dialysis at the sites before the filter,after the filter and at the arterial end.NM concentration and activated clotting time(ACT)were measured in these blood samples.Results At the time points of 1h,2h,3h and 4h during dialysis,the ACT values showed significant differences in the blood samples before the filter,after the filter and from arterial end(F=21.899,27.464,8.264 and 8.162 respectively;P<0.001,<0.001,=0.001 and=0.001 respectively);the ACT values of different sites at the same time point showed that the ACT value of arterial end was the lowest,followed by the value after filter and then the value before filter.At the time points of 1h,2h,3h and 4h during dialysis,the NM blood concentrations were significantly different in the blood samples before the filter,after the filter and from arterial end(F=46.547,20.059,16.582 and 16.687 respectively;P<0.001);the NM blood concentrations of different sites at the same time point showed that the NM blood concentration of arterial end was the lowest,followed by the value after filter and then the value before filter.Conclusion Nafamostat mesylate effectively serves as an anticoagulant in the extracorpo-real circulation during hemodialysis.It possesses the characteristics of high dialysis clearance rate and rapid metabolism in the body with a minimal impact on systemic coagulation status.It is a new choice of anticoagulant for patients undergoing hemodialysis with high risk of bleeding.