摘要
目的评估甲磺酸萘莫司他体外抗凝在脓毒症合并急性肾损伤(acute kidney injury,AKI)患者连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)中的有效性和安全性。方法研究对象为在四川大学华西医院接受CRRT的伴有高出血风险的脓毒症合并AKI患者。纳入2021年7月-2022年1月接受甲磺酸萘莫司他体外抗凝治疗的CRRT患者作为萘莫司他组;回顾性收集2020年1月-12月未使用抗凝剂的CRRT患者病历资料,将其作为对照组。分析两组患者的一般情况、CRRT的第1个滤器寿命、治疗72 h滤器使用数量、治疗前后实验室检查、治疗期间发生不良反应的情况。结果对照组患者42例,萘莫司他组患者21例。两组患者的年龄、性别、体质量指数、平均动脉压、原发病、序贯器官衰竭估计评分、急性生理学和慢性健康状况评价Ⅱ评分、治疗前实验室检查结果差异均无统计学意义(P>0.05)。Kaplan-Meier生存分析显示,萘莫司他组患者第1个滤器寿命长于对照组患者(风险比=0.408,P<0.05)。对照组患者治疗72 h使用滤器数量多于萘莫司他组患者[(2.1±0.6)vs.(1.3±0.5)个,P<0.05]。治疗72 h后,萘莫司他组患者的血清肌酐[(99.4±15.7)vs.(127.6±20.5)μmol/L]、尿素氮[(4.5±1.9)vs.(6.8±2.3)mmol/L]、半胱氨酸蛋白酶抑制剂C[(1.0±0.2)vs.(1.2±0.2)mg/L]、尿酸[(86.5±15.3)vs.(105.3±20.3)μmol/L]低于对照组患者(P<0.05),其余实验室检查结果差异均无统计学意义(P>0.05)。两组患者的不良反应差异无统计学意义(P>0.05)。结论对于接受CRRT的伴有高出血风险的脓毒症合并AKI患者的体外抗凝,甲磺酸萘莫司他可能是一种安全有效的抗凝剂。
Objective To evaluate the efficacy and safety of in vitro anticoagulation with nafamostat mesilate in continuous renal replacement therapy(CRRT)in patients with sepsis complicated with acute kidney injury(AKI).Methods The study subjects were sepsis patients with AKI who underwent CRRT in West China Hospital of Sichuan University and were at high risk of bleeding.CRRT patients who received in vitro anticoagulation with nafamostat mesilate between July 2021 and January 2022 were included in the nafamostat group.The medical records of CRRT patients who did not use anticoagulants between January 2020 and December 2020 were retrospectively collected as a control group.The general situation,the lifespan of the first CRRT filter,the number of filters used within 72 hours of treatment,laboratory tests before and after treatment,and the occurrence of adverse reactions during treatment of the two groups of patients were analyzed.Results There were 42 patients in the control group and 21 patients in the nafamostat group.There was no statistically significant difference in age,gender,body mass index,mean arterial pressure,primary disease,Sequential Organ Failure Assessment score,Acute Physiology and Chronic Health EvaluationⅡscore,and pretreatment laboratory test results between the two groups of patients(P>0.05).Kaplan-Meier survival analysis showed that the lifespan of the first filter was longer in the nafamostat group than in the control group(hazard ratio=0.408,P<0.05).The number of filters used by the control group patients after 72 hours of treatment was greater than that of the nafamostat group patients(2.1±0.6 vs.1.3±0.5,P<0.05).After 72 hours of treatment,serum creatinine levels[(99.4±15.7)vs.(127.6±20.5)μmol/L],urea nitrogen[(4.5±1.9)vs.(6.8±2.3)mmol/L],cystatin C[(1.0±0.2)vs.(1.2±0.2)mg/L],uric acid[(86.5±15.3)vs.(105.3±20.3)μmol/L]in the nafamostat group were lower than those of the control group(P<0.05),and there was no statistically significant difference in the results of other laboratory tests(
作者
朱倩莹
程立新
黄兰
范晴
何宣辰
王芳
陈芳
杨莹莹
张凌
付平
ZHU Qianying;CHENG Lixin;HUANG Lan;FAN Qing;HE Xuanchen;WANG Fang;CHEN Fang;YANG Yingying;ZHANG Ling;FU Ping(Department of Nephrology,Kidney Research Institute,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Department of Nephrology,Ya’an No.2 People’s Hospital,Ya’an,Sichuan 625000,P.R.China;Department of General Practice,No.5 People’s Hospital Affiliated to Chengdu University of Traditional Chinese Medicine,Chengdu,Sichuan 611130,P.R.China)
出处
《华西医学》
CAS
2023年第5期718-723,共6页
West China Medical Journal
基金
四川省科学技术厅应用基础项目(2021YJ0219)
四川大学华西医院横向课题(HX-H2105130)。
关键词
甲磺酸萘莫司他
脓毒症
急性肾损伤
连续性肾脏替代治疗
抗凝
Nafamostat mesilate
sepsis
acute kidney injury
continuous renal replacement therapy
anticoagulation
