甲磺酸萘莫司他与枸橼酸抗凝在慢性肾衰竭伴高危出血患者连续性肾替代治疗中的疗效评估

Evaluation of the efficacy and safety of nafamostat mesylate anticoagulation and citric acid anticoagulation in chronic renal failure patients with high-risk bleeding during continuous renal replacement therapy

目的评价在慢性肾衰竭伴高危出血患者中行连续性肾替代治疗(CRRT)应用甲磺酸萘莫司他(NM)与局部枸橼酸(CA)抗凝的安全性和有效性。方法回顾性研究2021年1月至2023年9月在本中心接受NM或CA抗凝的慢性肾衰竭伴高危出血患者,评估滤器寿命或出血及其他并发症,采用多因素Cox回归分析确定滤器衰竭相关危险因素。结果共纳入125例患者,其中59例接受CA抗凝,66例接受NM抗凝。与CA组相比,NM组高血压、冠心病比例较高,两组在其他基线特征上无显著性差异。CA组滤器寿命长于NM组[12(8~24)h vs.8(8~13.13)h,P=0.003],NM组滤器衰竭的风险显著增高(HR=22.886,95%CI:3.935~133.12,P<0.001),但在8 h以内,两种抗凝滤器凝血率相当。CA组新发出血6例(10.17%),与NM组9例(13.64%)相当(P=0.552)。两组输血浆、红细胞、血小板均无差异。CA组代谢性碱中毒(5.08%)发生率略高于NM组(4.55%)(P=0.042)。结论在慢性肾衰竭伴高危出血患者CRRT中,使用NM与局部CA相比出血风险相当,抗凝效果稍差,但可满足8 h内的治疗需要。

Objective To evaluate the safety and efficacy of nafamostat mesylate(NM)and regional citric acid(CA)anticoagulation in continuous renal replacement therapy(CRRT)in chronic renal failure patients with high-risk bleeding.Methods A retrospective study was conducted in chronic renal failure patients with high-risk bleeding who received NM or CA anticoagulation at our center from January 2021 to September 2023 to assess filter lifespan or bleeding and other complications.Multifactor Cox regression analysis was used to determine the risk factors associated with filter failure.Results A total of 125 cases were included,of which 59 received CA anticoagulant and 66 received NM anticoagulant.Compared with the CA group,the NM group had higher rates of hypertension and coronary heart disease,and there was no significant difference in other baseline characteristics between the two groups.The filter lifespan of CA group was longer than that of NM group[12 h(8~24)vs 8 h(8~13.13),P=0.003].Patients in the NM group had a significantly higher risk of filter failure(HR=22.89,95%CI 3.935~133.12,P<0.001).However,in CRRT less than 8 hours,the clotting rate of the two anticoagulant methods was comparable.There were 6 cases(10.17%)of new bleeding in CA group,which was similar to 9 cases(13.64%)in NM group(P=0.552).The transfusion of plasma,red blood cells and platelets were not different between the two groups.The incidence of metabolic alkalosis(5.08%)in CA group was slightly higher than that(4.55%)in NM group(P=0.042).Conclusion Compared with CA anticoagulation in CRRT at high risk of bleeding in chronic renal failure,the anticoagulation effect of NM is slightly worse,however its risk of bleeding is comparable with CA anticoagulation,and it can meet the treatment within 8 h.