萘莫司他对血液透析高危出血倾向患者的治疗效果研究

Therapeutic effect of Nafamostat on hemodialysis patients with high risk of bleeding tendency

目的 研究萘莫司他对血液透析高危出血倾向患者的治疗效果。方法 以2021年5月-2023年3月哈尔滨二四二医院收治的血液透析高危出血倾向患者112例为研究对象,采用随机数字表法分为对照组和观察组,各56例。所有患者透析期间均进行抗凝治疗,其中对照组进行无肝素抗凝,观察组采用萘莫司他抗凝,2组均观察至透析完成。比较2组透析情况、透析前后电解质、营养指标、凝血功能、肾功能及透析后透析充分性。结果 观察组血滤器使用时间长于对照组,静脉壶抗凝有效率高于对照组(P <0.05);透析后与透析前比较,2组血清钠离子水平升高,且观察组高于对照组,2组血清钾离子、血肌酐(Scr)、尿素氮(BUN)水平降低,观察组低于对照组(P <0.05);透析后与透析前比较,对照组血小板水平降低,且低于观察组(P <0.05);血清D-二聚体(D-D)水平升高,且高于观察组,观察组部分凝血活酶时间(APTT)、凝血酶原时间(PT)延长,且长于对照组(P <0.05);透析后,观察组尿素清除率(KT/V)高于对照组(P <0.05)。结论 与无肝素抗凝相比,采用萘莫司他对血液透析高危出血倾向患者进行抗凝治疗,可有效改善患者透析情况,调节电解质水平及凝血功能,提高患者透析充分性,同时不会对营养状态产生较大影响,具有较好的应用效果。

Objective To study the therapeutic effect of Nafamostat on hemodialysis patients with high risk of bleeding tendency.Methods A total of 112 patients with high risk of bleeding tendency during hemodialysis admitted to Harbin 242 Hospital from May 2021 to March 2023 were selected as the study objects and divided into the control group(56 cases)and the observation group(56 cases)according to random number table method.All patients received anticoagulation treatment during dialysis.The control group was treated with anticoagulation without heparin,and the observation group was treated with anticoagulation with Nafamostat.Both groups were observed till dialysis was completed.The dialysis status,electrolytes before and after dialysis,nutritional indexes,coagulation function,renal function and dialysis adequacy were compared between two groups.Results In the observation group,the use time of blood filter was longer than that in the control group,and the anticoagulant efficiency of the venous kettle was higher than that in the control group(P<0.05).After dialysis,compared with before dialysis,the serum sodium ion levels in two groups increased,and the observation group was higher than the control group(P<0.05);The levels of serum potassium ion,serum creatinine(Scr)and urea nitrogen(BUN)in two groups decreased,and the observation group was lower than the control group(P<0.05).After dialysis,compared with before dialysis,the platelet levels in the control group decreased and were lower than those in the observation group(P<0.05);The level of plasma D-dimer(D-D)in the control group increased and was higher than that in the observation group(P<0.05);The partial thromboplastin time(APTT)and prothrombin time(PT)in the observation group were prolonged and longer than those in the control group(P<0.05).After dialysis,the urea clearance rate(KT/V)in the observation group was higher than that in the control group(P<0.05).Conclusion Compared with anticoagulation without heparin,the use of Nafamostat in hemodialysis patients with high-risk of bleeding tendency can effectively improve the dialysis condition of patients,regulate electrolyte level and coagulation function,improve dialysis adequacy of patients,and do not have a greater impact on nutritional status.It has a good application effect.