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甲磺酸萘莫司他在尿毒症患者不同稀释方式连续性静脉-静脉血液滤过治疗中的抗凝效果评价
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| 篇名： | 甲磺酸萘莫司他在尿毒症患者不同稀释方式连续性静脉-静脉血液滤过治疗中的抗凝效果评价 |
| TITLE： | Evaluation of the anticoagulant effect of nafamostat mesylate in continuous veno-venous hemofiltration with different dilution methods for uremic patients |
| 摘要： | 目的 评价甲磺酸萘莫司他（NM）在高出血风险尿毒症患者不同稀释方式（前/后稀释）连续性静脉-静脉血液滤过（CVVH）治疗中的抗凝有效性及安全性。方法选取2023年7月至2024年9月在重庆大学附属三峡医院肾病学科行CVVH治疗的高出血风险尿毒症患者130例，按随机数字表法分为前稀释组和后稀释组，每组65例。2组患者均在NM抗凝下接受CVVH治疗，前稀释组采用前稀释置换方式，后稀释组采用后稀释置换方式。比较2组患者滤器及透析管路静脉壶的凝血情况、压力情况及使用时长，CVVH治疗1、4、7h时肝素泵前、滤器后及治疗结束20min时外周静脉血凝血酶原时间（PT）、凝血酶原时间国际标准化比值（PT-INR）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）的变化情况，单室尿素清除指数（spKt/V）、β2-微球蛋白（β2-MG）清除率以及药物不良反应发生率。结果前、后稀释组各有60例患者完成研究。后稀释组患者滤器和静脉壶Ⅱ～Ⅲ级凝血发生率、跨膜压和静脉压报警干预人数均显著高于或多于前稀释组（P＜0.05），滤器和透析管路使用时间均显著短于前稀释组（P＜0.05）。后稀释组患者CVVH治疗1、4、7h时的肝素泵前APTT以及滤器后PT、APTT均显著长于前稀释组（P＜0.001）；2组患者治疗结束20min时的PT、PT-INR、APTT、FIB差异均无统计学意义（P＞0.05）。后稀释组患者的spKt/V、β2-MG清除率均显著高于前稀释组（P＜0.001）。2组患者药物不良反应发生率的差异无统计学意义（P＞0.05）。结论NM作为抗凝剂应用于高出血风险尿毒症患者CVVH治疗时，后稀释方式相较于前稀释方式，滤器及透析管路静脉壶的凝血发生率更高，滤器和透析管路使用时间更短，对体外抗凝影响更大，但具有更高的溶质清除率。临床上可根据患者的不同治疗需求选择CVVH的不同稀释方式。 |
| ABSTRACT： | OBJECTIVE To evaluate the anticoagulant efficacy and safety of nafamostat mesylate （NM） in the treatment of uremic patients at high risk of bleeding undergoing continuous veno-venous hemofiltration （CVVH） with different methods （pre- dilution and post-dilution）. METHODS A total of 130 uremic patients at high risk of bleeding who underwent CVVH treatment in the nephrology department of Chongqing University Three Gorges Hospital from July 2023 to September 2024 were selected. They were divided into pre-dilution group and post-dilution group according to the random number table method， with 65 cases in each group. Both groups of patients received CVVH treatment under NM anticoagulation. The pre-dilution group adopted the pre-dilution replacement method， while the post-dilution group adopted the post-dilution replacement method. The coagulation， pressure， and usage duration of the filter and dialysis circuit venous reservoirs were compared between the two groups. The changes in prothrombin time （PT）， prothrombin time-international normalized ratio （PT-INR）， activated partial thromboplastin time （APTT）， and fibrinogen （FIB） in the peripheral venous blood before the heparin pump and after the filter at 1， 4 and 7 h of CVVH treatment， as well as 20 min after the end of treatment， were compared between the two groups. The single-compartment urea clearance rate （spKt/V）， β2-microglobulin （β2-MG） clearance rate and the incidence of adverse reactions were duni2007@foxmail.com compared between the two groups. RESULTS Both the pre-dilution and post-dilution groups had 60 patients who completed the study. The incidence of grade Ⅱ-Ⅲ coagulation of the filter and venous reservoirs， as well as the number of patients with transmembrane and venous pressure alarm intervention in the post- dilution group were significantly higher or more than those in the pre-dilution group （P＜0.05）， while usage time of the filter and the pipeline in the post-dilution group was significantly shorter than that in the pre-dilution group （P＜0.05）. The APTT values before the heparin pump as well as PT and APTT values after the filter at 1 h， 4 h， and 7 h of CVVH treatment in the post-dilution group were significantly higher than those in the pre-dilution group （P＜0.001）. There were no significant differences in PT， PT- INR， APTT and FIB between the two groups of patients 20 min after the end of treatment （P＞0.05）. The spKt/v and β2-MG clearance rates in the post-dilution group were significantly higher than those in the pre-dilution group （P＜0.001）. There was no significant difference in the incidence of adverse reactions between the two groups （P＞0.05）. CONCLUSIONS When NM is used as an anticoagulant in the CVVH treatment of uremic patients at high risk of bleeding， compared with the pre-dilution treatment method， the post-dilution treatment method has a higher incidence of filter and dialysis tubing venous reservoir， a shorter usage time of the filter and pipeline， and a greater impact on extracorporeal coagulation， but has a higher solute clearance rate. Clinically， different dilution methods can be selected according to the different treatment needs of patients. |
| 期刊： | 2026年第37卷第03期 |
| 作者： | 沈莉；张尧；王军；朱虹；覃勇；汤跃武；杜妮 |
| AUTHORS： | SHEN Li，ZHANG Yao，WANG Jun，ZHU Hong，QIN Yong，TANG Yuewu，DU Ni |
| 关键字： | 甲磺酸萘莫司他；连续性静脉-静脉血液滤过；置换液稀释方式；连续性肾脏替代治疗；抗凝；出血风险；尿毒症 |
| KEYWORDS： | nafamostat mesylate； continuous veno-venous hemofiltration； dilution method of replacement fluid； continuous |
| 阅读数： | 4 次 |
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