枸橼酸钠与阿加曲班在危重患者连续性静脉-静脉血液滤过治疗中的抗凝效果比较

目的：对比枸橼酸钠和阿加曲班在危重患者连续性静脉-静脉血液滤过( CVVH)治疗中的抗凝效果和安全性,优化危重症患者连续性血液净化的抗凝方案。方法广州医科大学附属第三医院2014年6月—2015年5月收治危重患者共134例,按随机抽样原则分为枸橼酸钠组59例、阿加曲班组75例,记录并对比两组的一般情况、CVVH治疗时间、凝血功能、血常规和生化检查等项目。结果阿加曲班用量与APACHEⅡ评分呈负相关。阿加曲班组治疗前、后凝血酶原时间( PT)、活化部分凝血活酶时间( APTT)、国际标准化比值( INR)、纤维蛋白原( Fb)比较差异有统计学意义(P<0．01),治疗后PT、APTT和INR与枸橼酸钠组比较差异亦有统计学意义(P<0．05,P<0．01)。两组均未并发出血不良事件。两组治疗前、后 pH值均在正常值范围内,阿加曲班组治疗后 pH 值显著高于治疗前(P<0．05)；两组治疗前、后白细胞、红细胞压积(HCT)、血肌酐、血钠和血钾比较差异均无统计学意义(P>0．05)。枸橼酸钠组CVVH治疗开始时、结束前滤器后血钙与体内血钙比较差异均有统计学意义(P<0．01)；阿加曲班组与枸橼酸钠组相同时点滤器后血钙比较差异亦有统计学意义(P<0．01)。结论枸橼酸钠和阿加曲班在危重症患者CVVH治疗中的应用均安全有效。枸橼酸钠更适合应用于有出血风险的危重症患者；阿加曲班在肾功能不全的患者中仍能安全使用,且代谢迅速、易于监测,亦为危重患者CVVH治疗中抗凝药物的较佳选择。

Comparison of the Anticoagulant Effect between Sodium Citrate and Argatroban during Continuous Veno-ve-nous Hemofiltration Therapy for Critical Patients

Objective To contrast the anticoagulant effect and safety between Sodium Citrate and Argatroban during continuous veno-venous hemofiltration ( CVVH) therapy for critical patients so as to optimize anticoagulation meth-od for critical patients during continuous blood purification. Methods A total of 134 critical patients during June 2014 and May 2015 were divided into Sodium Citrate group (n=59) and Argatroban group (n=75) according to the principle of random sampling. The general condition, CVVH therapeutic time, blood clotting function, routine blood and biochemi-cal examinations were recorded and compared in the two groups. Results The Argatroban dosage showed negative corre-lation with acute physiology and chronic health evaluation II ( APACHE II) score. There were significant differences in prothrombin time ( PT) , activated partial thromboplastin time ( APTT) , international normalized ratio ( INR) and fibrin-ogen ( Fb) before and after the treatment in Argatroban group ( P<0. 01 ) . There were significant differences in PT, APTT and INR values after the treatment between Argatroban and Sodium Citrate groups (P<0. 05, P<0. 01). No com-plicated hemorrhage was found in the two groups. The PH values before and after the treatment in the two groups were in the normal range, and the value after the treatment was significantly higher than that before the treatment in Argatroban group (P<0. 05). There were no significant differences in values of hematocrit (HCT) of leukocyte and red blood cell, serum creatinine, serum sodium and serum potassium before and after the treatment in the two groups (P>0. 05). There were significant differences in values of serum calcium in vivo and vitro after the filter between beginning and before the end of CVVH treatment in the Sodium Citrate group (P<0. 01). There was significant difference in serum calcium at the same time point after the filter between Argatroban and Sodium Citrate groups (P<0. 01). Conclusion Sodium Citrate and Argatroban are safe and effective in application of CVVH therapy for critical patients. Sodium Citrate is more suitable for the critical patients with bleeding risk, and Argatroban is safe and effective in treatment of patients with renal insuffi-ciency with rapid metabolism and easy monitoring, and therefore it is a good choice of anticoagulant drugs during CVVH therapy for critical patients.