甲磺酸奈莫司他抗凝治疗在维持性血液透析治疗中的应用

The application of nemolimus mesylate anticoagulant therapy in maintenance hemodialysis treatment

目的探讨甲磺酸奈莫司他抗凝治疗在维持性血液透析治疗中的应用效果。方法选取天津市滨海新区海滨人民医院2023年1月-2023年10月收治的80例维持性血液透析患者,应用随机数字表法分为观察组与对照组,每组各40例。对照组采取常规肝素钠抗凝,观察组采取甲磺酸奈莫司他抗凝。对比两组抗凝效果,凝血功能相关指标变化,红细胞压积及红细胞黏附率,丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、血肌酐(Scr)、尿素氮(BUN)肝肾功能相关指标变化,不良反应发生率。结果两组透析器凝血分级对比无差异(P>0.05),观察组动脉穿刺点压迫止血时间明显短于对照组(P<0.05);治疗后两组纤维蛋白原(FIB)、凝血酶原时间(PT)水平无明显变化,D-二聚体(D-D)水平降低,但观察组与对照组相比无明显差异(P>0.05),治疗后活化部分凝血活酶时间(APTT)升高,观察组APTT低于对照组(P<0.05);治疗后两组红细胞压积、红细胞黏附率降低(P<0.05),但观察组与对照组相比无明显差异(P>0.05);治疗后两组ALT、AST无明显变化,组间对比无明显差异(P>0.05),Scr、BUN水平均降低,且观察组低于对照组(P<0.05);观察组不良反应发生率明显低于对照组(P<0.05)。结论甲磺酸奈莫司他抗凝在维持性血液透析治疗中应用效果显著,抗凝效果与低分子肝素效果相当,但凝血功能迅速恢复,APTT无明显增加,且采取甲磺酸奈莫司他抗凝治疗可进一步缩短患者动脉穿刺点压迫止血时间,改善肾功能,且安全性较高。

Objective To explore the application effect of anticoagulant therapy with nemolimus mesylate in maintenance hemodialysis treatment.Method Admitted to our hospital from January 2023 to October 2023 were selected and divided into observation group and control group with 40 cases each.The control group took conventional heparin sodium anticoagulation,and the observation group received nerimostat mesylate anticoagulant.Compared with the anticoagulant effect of the two groups,the changes of coagulation function,hematocrit and red blood cell adhesion rate,the changes of alanine aminotransferase(ALT),aspartate aminotransferase(AST),serum creatinine(Scr),urea nitrogen(BUN),and the incidence of adverse effects.Result There was no significant difference in clotting grading of dialyzers between the two patient groups(P>0.05),the observation group had a significantly shorter compression hemostasis time at the arterial puncture point compared to the control group(P<0.05);after treatment,there was no significant change in FIB and PT levels between the two patient groups,while D-dimer(D-D)levels decreased.However,there was no significant difference between the observation group and the control group(P>0.05).After treatment,activated partial thromboplastin activated time(APTT)increased and APTT in the observation group was lower than in the control group(P<0.05);after treatment,haematocrit and red blood cell adhesion rates of the two patient groups decreased(P<0.05),but there was no significant difference between the observation group and the control group(P>0.05);after treatment,there were no significant changes in ALT and AST values between the two patient groups,and there was no significant difference between the groups(P>0.05).Scr and BUN values decreased,and the observation group was lower than the control group(P<0.05);the incidence of adverse reactions in the observation group was significantly lower than in the control group(P<0.05).Conclusion Namostat mesylate anticoagulation in maintenance hemodialysis treatment application effect,anticoagulant effect of low molecular weight heparin,but the coagulation function is quickly restored,APTT no significant extension,and namostat mesylate anticoagulant therapy can further shorten the arterial point compression hemostasis time,improve renal function,and high safety.