CAJ | 학술논문

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(P<0.01),阿加曲班组血小板数无明显改变(P>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(P<0.01)；阿加曲班组治疗结束后1 h APTT基本恢复正常(P>0.05),而普通肝素组仍高于治疗前(P<0.01),2组差异有统计学意义(P<0.01)；阿加曲班组和普通肝素组在CVVH治疗结束后管路和滤器凝血发生率以及CVVH治疗后24 h内出血事件的发生率差异均无统计学意义(P>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。
목적：：탐토아가곡반여보통간소재련속성정맥-정맥혈액려과( CVVH)치료중항응작용화안전성비교。방법：장40례신공능불전수행CVVH치료적환자수궤분성아가곡반조화보통간소조각20례,분별사용아가곡반화보통간소항응。검사환자CVVH치료전후혈소판화신공능,제1、4、8 h、치료결속전이급치료결속후1 h적활화부분응혈활매시간( APTT)。관찰치료과정중관로화려기응혈정황,감측환자치료결속후24 h내유무출혈사건적발생。결과：CVVH치료후,보통간소조혈소판수량교치료전명현하강(P<0.01),아가곡반조혈소판수무명현개변(P>0.05)；아가곡반조화보통간소조APTT재CVVH치료후1 h화치료결속전연장시간차이균유통계학의의(P<0.01)；아가곡반조치료결속후1 h APTT기본회복정상(P>0.05),이보통간소조잉고우치료전(P<0.01),2조차이유통계학의의(P<0.01)；아가곡반조화보통간소조재CVVH치료결속후관로화려기응혈발생솔이급CVVH치료후24 h내출혈사건적발생솔차이균무통계학의의(P>0.05)。결론：아가곡반재CVVH치료중적항응작용여보통간소효과상당,정약후APTT회복교쾌,차대혈소판영향교소,안전성고,가능시CVVH치료중비교이상적항응제。
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.