阿加曲班预防半永久中心静脉导管血栓形成的疗效研究

目的 通过观察定期给半永久导管患者应用尿激酶、低分子肝素与阿加曲班预防血栓形成疗效的比较,探讨阿加曲班预防血栓形成的疗效及安全性.方法 从2011年1月～2012年12月观察西安交通大学第一附属医院半永久中心静脉置管维持性血液透析的患者60例,随机分阿加曲班组20例、尿激酶组20例和对照组（低分子肝素）20例,从2012年1月～2012年12月开始用药,每月给药1次,共12个月,观察3组预防用药前12个月和用药后12个月、3组间用药后在不良事件的发生率,透析中血流量、跨膜压及静脉压的变化,用药后CRP的变化及用药过程中并发症的比较.结果 阿加曲班组在用药中并发症发生率低于尿激酶、低分子肝素组,阿加曲班组、尿激酶组在治疗前12月、后12月的透析前抽吸不畅发生率（14.1％比4.3％）（14.2％比10.3％）（P＜0.05）,对照组（13.8％比13.2％）（P＞0.05）、阿加曲班、尿激酶组透析中干预的事件发生率（17.2％比4.8％）（14.2％比10.3％）（P＜0.05）,对照组（17.5％比17.1％）（P＞0.05）,预防用药后阿加曲班、尿激酶组的血流量都增加、跨膜压及静脉压降低（P＜0.05）,对照组（P＞0.05）,阿加曲班组治疗前12月、后12月的CRP比较（P＜0.05）,CRP逐渐降低.结论 定期给予半永久置管的透析患者滴注阿加曲班或尿激酶可预防溶栓的形成,增加透析中的血流量.阿加曲班比尿激酶安全性高,长期应用阿加曲班可减少炎症反应.

A research into argatroban in the prevention of thrombosis in semipermanent double channel catheter in MHD patients

Objective To examine argatroban in the Prevention of thrombosis of semipermanent double channel catheter in MHD patients,and compare the effect of preventing thrombosis between in using urokinase group,LMWH group and argatroban group,and investigate further the efficacy and safety of argatroban in preventing thrombosis.Methods The 60 patients of semipermanent double channel catheter were collected since Jan.2011 to Dec.2012,including 20 patients using urokinase group,20 patients using argatroban group and 20 patients the control group using LMWH,and drugs were taken monthly,a total of 12 months.The adverse events of pre-dialysis and intervention,blood flow,transmembrane pressure and venous pressure of dislysis were observed in three groups,and three groups were controled respectively before and after treatments.The changes of CRP were observed in three groups after treatments.Results Argatroban group,the incidence of complications is 17.5％,urokinase group is 29.16％ and the control group is 25.83％ ; argatroban group and urokinase group,the adverse events rate before and after treatments are 14.1％ vs.4.3％ （P＜0.05） and 14.2％ vs.10.3％ （P＜0.05）,and the control group is 13.8％ vs.13.2％ （P＞0.05）,and argatroban group and urokinase group,intervention rate before and after treatments are17.2％ vs.4.8％ （P＜0.05） and 14.2％ vs.10.3％ （P＜0.05）,the control is and 17.5％ vs.17.1％ （P＞0.05）,argatroban group and urokinase group,the blood flow are all increaseed before and after treatments,and transmembrane pressure and venous pressure are all reduced（P＜0.05）,while the control （P＞0.05）; argatroban group,the CRP gradually is reduced after 12 months treatments （P＜0.05）.Conclusion Argatroban or urokinase could prevent the thrombosis of semipermanent double channel catheter,which are dripped at regular period,and the blood flow of dialysis is increased; argatroban group has higher safety,less thrombosis incidence and inflammatory reaction than urokinase group