枸橼酸钠与阿加曲班在血液透析患者抗凝治疗中的效果比较

目的 比较枸橼酸钠与阿加曲班在血液透析患者抗凝治疗中的疗效及安全性.方法 12例存在出血倾向的血液透析患者采用数字表法随机分为2组,每组6例.阿加曲班组予2.5mg/h阿加曲班泵入,提前半小时停泵;枸橼酸钠组予4％枸橼酸钠200 ml/h动脉端泵入,维持至透析结束.透析过程中观察患者有无不适症状(包括发热、头痛、恶心、口唇发麻、手足抽搐、心室颤动或停搏)、心率、血压;监测透析中静脉压、动脉压变化.透析前、后检测患者外周血凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、离子(钾、钠、钙、磷)浓度、血气分析(pH值)情况.透析结束后观察透析器、动静脉壶凝血及患者出血情况,透析器凝血分为3度,Ⅰ°为透析器＜ 1/3出现凝血;Ⅱ°为透析器1/3 ～ 2/3出现凝血;Ⅲ°为透析器＞2/3出现凝血、动静脉壶根据有无血凝块监测.结果 (1)阿加曲班组1例出现头痛症状,其他无明显不适症状出现;透析中心率、血压、透析中动脉压及静脉压两组比较差异无统计学意义.(2)两组透析前PT、APT、PH、BE及离子钾、钠、钙、磷无明显差异;透析后阿加曲班组PT及APTT较透析前及枸橼酸组均明显延长,差异有统计学意义(P＜0.05).与透析前相比,透析后两组pH值及离子钙显著增高,离子钾、磷均显著下降,差异有统计学意义(P＜0.05);透析后枸橼酸钠组与阿加曲班组pH值及离子钾、钠、钙、磷无明显变化,差异无统计学意义.(3)透析结束后,枸橼酸钠组有1例出现透析器Ⅰ°凝血,无动静脉血凝块;阿加曲班组透析器有3例出现Ⅰ°凝血、1例出现Ⅱ°凝血、2例出现动静脉血凝块,两组比较差异无统计学意义.枸橼酸钠组患者透析后无出血倾向,阿加曲班组4例出现出血倾向,其中2例为伤口渗血、2例为原有出血加重,两组比较差异有统计学意义(P＜0.05).结论 阿加曲班与枸橼酸抗凝均是安全、可行的方法,且易于掌握,两者相比,枸橼酸不增加透析后的出血风险,是更为理想的血液透析抗凝方法.

Anticoagulative efficacy of sodium citrate vs argatroban in hemodialysis patients

Objective To observe the efficacy and safety of sodium citrate and argatroban on anticogulative efficacy in hemodialysis patients.Methods Twelve hemodialysis patients with hemorrhagic tendency were randomly divided into two groups:sodium citrate group(6 patients) using 4％ sodium citrate anticoagulant hemodialysis with infusion rate of 200 ml/h;argatrobanno group(6 patients) using argatroban with pumping rate of 2.5 mg/h and stop the pump half an hour ahead of time.Uncomfortable symptom,heart rate,blood pressure and intravenous and arterial pressure changes in dialysis,the clotting of dialyzers and lines were observed.PT,APTF,ion and blood gas analysis before and after dialysis were detected.Results (1) Headache symptoms were reported in 1 in argatroban group,but there was no significant difference in heart rate,blood pressure and intravenous and arterial pressure changes in dialysis.(2) There was no significant difference before dialysis in PT,APTT,PH,BE and blood ion.After dialysis,PT and APTT in argatroban group significantly extended as compared with sodium citrate group(P ＜ 0.05).Blood ionized calcium levels were higher than predialysis and ionized kalium and phosphor were lower than predialysis too.(P ＜ 0.05).(3) There were 1 cases of grade Ⅰ° coagulation in sodium citrate group and grade Ⅰ° coagulation in 3cases,grade Ⅱ° coagulation in 1 cases in argatroban group.There was no hemorrhagic tendency in sodium citrate group and 4 cases have hemorrhagic tendency in argatroban group.The hemorrhagic tendency have significantly difference in two groups.Conclusions sodium citrate and argatroban are safe and effective.sodium citrate does not increase the risk of bleeding after dialysis and it tend to be better than argatroban.