阿加曲班在血液净化治疗中的应用

目的观察阿加曲班在有高危出血倾向和肝素诱导血小板减少(HIT)患者血液净化治疗中的抗凝疗效和安全性。方法在我院血液净化中心治疗的有出血倾向和HIT的患者36例,分为阿加曲班组(20例)和无肝素组(16例),对两组的疗效和安全性进行比较。结果两组患者在性别、年龄、原发病及血液净化方式上比较差异无统计学意义,与无肝素组相比,阿加曲班组的治疗时间延长,差异有统计学意义(8.0±3.5)h vs(3.6±1.7)h,P<0.05],出血的发生率没有明显增加(5%vs 0,P>0.05),凝血发生率明显下降(10%vs 50%,P<0.05)。两组患者在治疗前的血红蛋白、血小板、白蛋白及血清肌酐水平及各项凝血指标相比,差异无统计学意义(P>0.05)。与无肝素组相比,阿加曲班组治疗后血清肌酐明显下降(312.9±171.8)μmol/L vs(455.1±289.3)μmol/L,P<0.05],PT、APTT及TT明显延长,纤维蛋白原(Fib)水平下降,其中APTT和TT延长差异有统计学意义(46.3±28.4)s vs(30.5±6.2)s;(74.5±25.4)s vs(25±2.7)s,P<0.05]。结论阿加曲班作为一种新型抗凝剂应用于有出血风险、围手术及HIT的急慢性肾功能不全患者血液净化治疗是一种很好的选择。

Application of argatroban in blood purification treatment

Objective To observe the anticoagulation efficacy and safety of argatroban in blood purification treatment of patients with high risk of bleeding or heparin-induced thrombocytopedia（ HIT）. Methods Patients with bleeding tendency or HIT in our blood purification centre were divided into argatroban group（ 20 cases） and non-heparin group（ 16cases）. The efficacy and safety of the two groups were compared. Results There was no difference in terms of gender,age,primary disease and blood purification pattern in the two groups. Compared with the non-heparin group,the treatment time in argatroban group was prolonged significantly（ 8. 0 ± 3. 5） h vs（ 3. 6 ± 1. 7） h,P〈0. 05],the incidence of bleeding in argatroban group did not significantly increased（ 5% vs 0,P〈0. 05）,while the incidence of coagulation significantly decreased（ 10% vs 50%,P〈0. 05）. There was no difference in serum hemoglobin,albumin and creatinine level,platelet account and coagulation index in two groups before treatment. Compared with non-heparin group,the serum creatinine levels in argatroban group decreased significantly after treatment （ 312. 9 ± 171. 8） μmol /L vs（ 455. 1 ±289. 3） μmol /L,P〈0. 05]. PT,APTT and TT were prolonged,the fibrinogen level decreased,APTT and TT were prolonged significantly（ 46. 3 ± 28. 4） s vs（ 30. 5 ± 6. 2） s,P〈0. 05;（ 74. 5 ± 25. 4） s vs（ 25 ± 2. 7） s,P〈0. 05]. Conclusion Argatroban as a new type of anticoagulant could be served as a good choice for blood purification therapy for those who has risk of bleeding,HIT,or perioperative conditions.