| 王婷婷,黄琪锋,朱永俊.不同抗凝方式对消化道出血患者CRRT的疗效及安全性比较.[J].中南医学科学杂志.,2025,(1):40-44. |
| 不同抗凝方式对消化道出血患者CRRT的疗效及安全性比较 |
| Comparison of the efficacy and safety of different anticoagulation methods for CRRT in patients with gastrointestinal bleeding |
| 投稿时间：2024-09-10 修订日期：2024-12-12 |
| DOI：10.15972/j.cnki.43-1509/r.2025.01.009 |
| 中文关键词: 无肝素 枸橼酸 阿加曲班 连续性肾脏替代治疗 消化道出血 抗凝方式 [ |
| 英文关键词:heparin-free citrate argatroban CRRT gastrointestinal bleeding anticoagulation methods |
| 基金项目:国家自然科学基金(地区科学基金项目)(82060143)；海南医学院第一附属医院青年培育基金项目(HYYFYPY202105)；海南省卫生健康行业科研项目(20A200424) |
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| 中文摘要: |
| 目的比较不同抗凝方式对消化道出血患者连续性肾脏替代治疗(CRRT)的疗效及安全性。 方法将255例CRRT患者根据不同抗凝方式分为无肝素组57例、局部枸橼酸抗凝(RCA)组102例和阿加曲班抗凝(ARG)组96例。根据患者消化道是否出血将RCA组和ARG组分为RCA无出血组(n＝40)、RCA出血组(n＝62)和ARG无出血组(n＝57)、ARG出血组(n＝39)。比较各组患者血常规、凝血功能、肝肾功能指标水平、疗效及并发症发生情况。 结果治疗后,各组血常规、凝血功能及肾功能均有所改善；ARG出血组红细胞计数低于RCA出血组(P＜0.05),RCA无出血组血小板计数高于ARG无出血组(P＜0.05)；无肝素组纤维蛋白原水平低于RCA出血组(P＜0.05)；ARG无出血组活化部分凝血活酶时间高于RCA无出血组(P＜0.05)；ARG出血组国际标准化比值高于RCA出血组(P＜0.05)。RCA出血组尿素氮水平低于无肝素组(P＜0.05)。无肝素组抗凝有效率低于RCA出血组及ARG出血组(P＜0.05)。各组肝功能指标水平及并发症发生率比较,差异无统计学意义(P＞0.05)。 结论在消化道出血患者CRRT抗凝方案的选择上,若无RCA或ARG禁忌证,则优先选择RCA或ARG抗凝方案；当存在活动性出血且对肝素类药物过敏或有其他抗凝药物禁忌证时,考虑应用无肝素抗凝方案。 |
| 英文摘要: |
| AimTo compare the efficacy and safety of different anticoagulation methods for continuous renal replacement therapy (CRRT) in patients with gastrointestinal bleeding. Methods255 CRRT patients were divided into 57 cases in the heparin-free group, 102 cases in the regional citrate anticoagulation (RCA) group and 96 cases in the argatroban anticoagulation (ARG) group according to the different anticoagulation methods. According to whether or not a patient has gastrointestinal bleeding, the RCA group and ARG group were divided into RCA no bleeding group (n＝40), RCA bleeding group (n＝62), ARG no bleeding group (n＝57), and ARG bleeding group (n＝39). The complete blood count, coagulation function, liver and kidney function indicators, efficacy, and incidence of complications among different groups were compared. ResultsAfter treatment, complete blood count, coagulation function, and renal function were improved in each group; The red blood cell count in the ARG bleeding group was lower than that in the RCA bleeding group (P＜0.05), and the platelet count in the RCA non bleeding group was higher than that in the ARG non bleeding group (P＜0.05); The fibrinogen level in the heparin-free group was lower than that in the RCA bleeding group (P＜0.05); The activated partial thromboplastin time in the ARG non bleeding group was higher than that in the RCA non bleeding group (P＜0.05); The level of international normalized ratio in the ARG bleeding group was higher than that in the RCA bleeding group (P＜0.05). The urea nitrogen level in the RCA bleeding group was lower than that in the heparin-free group (P＜0.05). The anticoagulant efficacy of the heparin-free group was lower than that of the RCA bleeding group and ARG bleeding group (P＜0.05). There was no statistically significant difference in the levels of liver function indicators and incidence of complications among the groups (P＞0.05). ConclusionTo choose anticoagulation regimen for CRRT in patients with gastrointestinal bleeding, priority is given to RCA or ARG anticoagulation regimens if there are no contraindications to RCA or ARG; when active bleeding exists and there is allergy to heparin analogues or contraindications to other anticoagulant medications, the application of heparin-free anticoagulation regimens should be considered. |
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