小剂量阿加曲班在连续性肾脏替代治疗中的疗效和安全性分析

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• 英文论文题名：Anticoagulative efficacy and safety of small-dose argatroban in continuous renal replacement therapy
• 论文作者：唐莲 ; 庄智伟 ; 赵富丽 ; 尚尔宁
• 年：2016
• 作者机构：苏州市立医院本部药学部;苏州市立医院本部急诊监护室;苏州市立医院本部重症监护室;
• 论文关键词：阿加曲班 ; 高出血风险 ; 连续性肾脏替代治疗 ; 凝血指标
• 英文论文关键词：argatroban ; high risk of bleeding ; CRRT ; coagulation parameters
• 会议召开时间：2016-09-27
• 会议录名称：中国药学会第十三届青年药学科研成果交流会论文集
• 语种：中文
• 分类号：R459.5
• 学会代码：YYWS
• 会议名称：中国药学会第十三届青年药学科研成果交流会
• 会议地点：中国江西南昌
• 主办单位：中国药学会
• 学会名称：中国药学会
• 页数：5
• 文件大小：377k
• 原文格式：O
• 会议级别：全国

摘要

目的:探讨小剂量阿加曲班在高出血风险患者行连续性肾脏替代治疗(CRRT)中的抗凝效果以及安全性。方法:入选高出血风险患者给予阿加曲班0.1-0.3μg/(kg·min)抗凝,评估凝血指标、滤器管路凝血事件、全身出血事件以及血象和肝功能指标。结果:共入选28例高出血风险患者行CRRT397周期,与CRRT前相比:治疗期间和CRRT结束后0-3h的活化部分凝血活酶时间(APTT)有显著差异(p=0.000);CRRT结束后≥3h的APTT无统计学差异。根据CRRT上机2-4h的APTT以及血液净化管路动静脉压情况调整阿加曲班给药剂量共114次,调整剂量后复测APTT较前降低,与CPRT上机2-4h相比具有统计学差异(P=0.034)。CRRT期间发生管路和滤器凝血事件共55周期(13.85%)。阿加曲班抗凝期间发生出血事件6例,其中气道出血3例,皮肤瘀斑2例,消化道出血1例,CRRT期间继续减量使用阿加曲班抗凝未观察到有出血加重事件。结论:APTT与阿加曲班抗凝剂量具有较好的相关性,在CRRT结束后凝血指标较快恢复正常,小剂量阿加曲班对高出血风险患者CRRT期间抗凝治疗具有较好的抗凝效果和安全性。
Objective To investigate the anticoagulative efficacy and safety of argatroban in patients with high risk of bleeding receiving continuous renal replacement therapy(CRRT).Methods Patients with high risk of bleeding were received argatroban 0.1-0.3μg/(kg·min) during CRRT therapy.Coagulation parameters,clotting events,systemic bleeding events were evaluated for the anticoagulative efficacy and safety of argatroban.Results 28 cases with high risk of bleeding received CRRT totally 397 cycles.Compared to before CRRT,activated partial thromboplastin time(APTT) of during CRRT and 3h after CRRT had significant difference.No difference was found before and 3h after CRRT.According to APTT of 2-4h starting CRRT and blood purification tubes arteriovenous pressure,argatroban had adjusted the dose for 114 times.APTT after dose adjustment was decreased and had significant difference,compared to APTT of 2-4h starting CRRT(P=0.034).The incidence of coagulation within the filter and/or the pipeline in the argatroban anticoagulation was 13.85%(55 cycles).There were 6cases of bleeding events,including three cases of trachea hemorrhage,two cases of skin ecchymosis and one case of gastrointestinal bleeding.There were no hemorrhage symptoms aggravated during decreased dosage of argatroban anticoagulation.Conclusion APTT has good correlation with the dosage of argatroban,the coagulation parameters recovered quickly after CRRT.Using small-dose argatroban as an anticoagulation in high risk of bleeding patients receiving CRRT had a good effect and high security.

引文

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