阿加曲班与肝素在血液透析抗凝治疗中作用的比较分析

目的：探讨阿加曲班（argatroban）在血液透析（hemodialysis,HD）抗凝治疗中作用的疗效及安全性.方法：将90例次HD患者随机分成实验组和对照组,实验组45例次,使用阿加曲班抗凝,对照组45例次,使用肝素抗凝,监测HD患者治疗前血路管动脉端、治疗中2 h、治疗结束前血路管动、静脉端及治疗后1 h活化部分凝血活酶时间（APTT）,治疗过程中管路和透析器凝血情况,治疗后穿刺点压迫止血平均时间及组织器官24 h内出血情况（包括牙龈出血、鼻衄、结膜出血、皮下出血点、血尿、黑便及便血等）.结果：实验组HD治疗中APTT明显延长,达到HD抗凝治疗要求,与HD治疗前比较差异有统计学意义（P＜0.01）;实验组与对照组治疗中APTT比较差异有统计学意义（P＜0.01）;实验组治疗后1 h APTT恢复基本正常,而对照组仍然很高,两组比较差异有统计学意义（P＜0.01）;实验组与对照组治疗中管路和透析器凝血情况比较差别不大,两组比较差异无统计学意义（P＞0.05）;实验组与对照组治疗后穿刺点压迫止血平均时间比较差异有统计学意义（P＜0.05）;实验组治疗后组织器官出血较对照组明显减少,两组比较差异有统计学意义（P ＜0.01）.结论：阿加曲班在HD抗凝治疗中与普通肝素效果相当,但出血风险少,安全性高,适用于有出血倾向的HD患者.

Comparative Analysis on Anticoagulative Efficacy of Argatroban and Heparin in Hemodialysis

Objective：To investigate the anticoagulative efficacy and safety of argatroban in hemodialysis. Methods ：90 ca-ses of maintenance hemodialysis patients were random divided into the experimental group （45 cases） and the comparison group （45 cases） , The experimental group used argatroban and the comparison group used heparin for anticoagulation. Then monitoring activated partial thromboplastin time （AFFr） of artery pipeline of hemodialysis at before and after one hour of treatment, AtrlT of artery and vein pipeline of hemodialysis during treatment, coagulation within the pipeline and filter were observed during treatment. Time of pres sure puncture part for hemostasia were observed, Bleeding event（ include gum Bleeding,nose Bleeding ,conjunctiva Bleeding,mucocu taneous hemorrhage and hematochezia, et al. ） after treatment were observed too. Results：The experimental group of APTT of vein pipeline of hemodialysis during treatment obvious high than before treatment（ P 〈 0.01 ） , APTY of artery and vein pipeline of hemodi alysis during treatment of the comparison group obvious high than the experimental group（ P 〈 0.01 ） ; APTT of artery of hemodialysis after one hour treatment of the comparison group obvious high than the experimental group （P 〈 0.01 ） ;Coagulation within the pipeline and filter no obvious difference on the experimental group and the comparison group（ P 〉 0.05 ） ; Bleeding event of tissue and apparatus of the comparison group obvious high than the experimental group （ P 〈 0.01 ）. Conclusion： This study has revealed anticoagulative ef- ficacy of argatroban same to heparin, Safety of argatroban tends to be better than heparin on hemodialysis, Argatroban more fit use on easy bleeding patient for hemodialysis treatment.