高出血风险患者连续性肾脏替代治疗期间采用阿加曲班和枸橼酸钠抗凝治疗的对比研究

目的 评估小剂量阿加曲班与枸橼酸钠在高出血风险患者连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)中的抗凝效果及安全性。方法 前瞻性收集125例患者分为枸橼酸钠组(n=53)和阿加曲班组(n=72)。比较2组CRRT滤器寿命、凝血功能指标、滤器及管路凝血事件、血栓事件、出血事件、CRRT参数及临床指标情况。结果 阿加曲班组治疗后的凝血酶原时间、国际标准化比值、活化部分凝血活酶时间与枸橼酸钠组相比均有延长(P<0.05)。2组的凝血事件差异无统计学意义，但是枸橼酸钠组的静脉壶无凝血比例高于阿加曲班组(P<0.05)，滤器寿命也更长(P<0.05)。枸橼酸钠组总不良反应发生率高于阿加曲班组(P=0.001)。2组发生滤器凝血事件的血流量和超滤率均低于未发生滤器凝血事件的血流量和超滤率(P<0.05)。结论 枸橼酸钠在CRRT中的抗凝效果更具优势，但阿加曲班安全性更好，对于低血流量和低超滤率的CRRT宜增加阿加曲班抗凝剂量。

Comparative Study of Argatroban and Sodium Citrate on Continuous Renal Replacement Therapy Anticoagulation in Patients with High Risk of Bleeding

OBJECTIVE To evaluate the anticoagulant effect and safety of low-dose argatroban and sodium citrate in continuous renal replacement therapy(CRRT) patients with high risk of bleeding. METHODS The 125 patients were prospectively divided into sodium citrate group(n=53) and argatroban group(n=72). CRRT filter life, coagulation function indexes, filter and pipeline clotting events, thrombosis events, bleeding events, CRRT parameters, and clinical indexes were compared between the two groups. RESULTS After treatment, the prothrombin time, international standardized ratio, and activated partial thromboplastin time of argatroban group were prolonged when compared with those of sodium citrate group(P<0.05). There were no significant difference in coagulation events between the two groups, but the proportion of non-coagulation in venous pot of sodium citrate group was higher than that of argatroban group(P<0.05), and the filter life was also longer(P<0.05). The incidence of total adverse reactions in the sodium citrate group was higher than that in the argatroban group(P=0.001). The blood flow and ultrafiltration rate in whom had filter clotting events were lower than those in whom had not filter clotting events(P<0.05). CONCLUSION Sodium citrate has a better anticoagulant effect in CRRT, however, argatroban has a better safety. The dose of argatroban should be increased in CRRT with low blood flow and low ultrafiltration rate.