阿加曲班与普通肝素在连续性血液滤过抗凝中的作用比较

目的:探讨阿加曲班与普通肝素在连续性静脉-静脉血液滤过(CVVH)治疗中抗凝作用和安全性比较。方法:将40例肾功能不全需行CVVH治疗的患者随机分成阿加曲班组和普通肝素组各20例,分别使用阿加曲班和普通肝素抗凝。检查患者CVVH治疗前后血小板和肾功能,第1、4、8 h、治疗结束前以及治疗结束后1 h的活化部分凝血活酶时间(APTT)。观察治疗过程中管路和滤器凝血情况,监测患者治疗结束后24 h内有无出血事件的发生。结果:CVVH治疗后,普通肝素组血小板数量较治疗前明显下降(PP>0.05);阿加曲班组和普通肝素组APTT在CVVH治疗后1 h和治疗结束前延长时间差异均有统计学意义(PP>0.05),而普通肝素组仍高于治疗前(PPP>0.05)。结论:阿加曲班在CVVH治疗中的抗凝作用与普通肝素效果相当,停药后APTT恢复较快,且对血小板影响较小,安全性高,可能是CVVH治疗中比较理想的抗凝剂。

Comparision of anticoagulative effect between argatroban and heparin during the continuous veno-venous hemofiltration

Objective:To compare the anticoagulative effects and safety between argatroban and heparin in continuous veno-venous hemofiltration( CVVH ) therapy. Methods:Forty renal insufficiency patients were randomly divided into the argatroban group and heparin group(20 cases each group). The argatroban group and heparin group were treated with argatroban and heparin,respectively. The platelet(PLT) and renal function before and after treatment,and activated partial thromboplastin time(APTT)after 1,4 and 8 h of the beginning of treatment,before the end of treatment and after 1h of treatment were detected. The blood coagulation of pipe and filter during treatment,and bleeding after 24 h of the end of treatment were observed. Results:Compared with before treatment,the number of PLT in heparin group decreased dramatically(P<0. 01),and the number of PLT in argatroban group did not significantly change after CVVH treatment(P>0. 05). The differences of APTT between argatroban group and heparin group after CVVH and before the end of treatment were statistically significant(P<0. 01). After 1h of treatment,the APPT in argatroban group almost arrived at normal(P>0.05),but for heparin group,the APPT was still higher than that before treatment(P <0. 01),the difference of which was not statistically significant(P<0. 01). The differences of the incidence of coagulation in the pipeline and filter,and bleeding after 24 h of CVVH treatment between two groups were not statistically significant(P>0. 05). Conclusions:The anticoagulative effect of argatroban in CVVH treatment is similar to the heparin,the recovery of CVVH is quick after stopping drug. The argatroban is good effect and high safety,which maybe an ideal anticoagulant in CVVH treatment.