| 摘要: |
| 目的：评估在接受体外膜肺氧合（ECMO）串联连续肾脏替代治疗（CRRT）时，采用肝素附加甲磺酸萘莫司他抗凝的安全性与有效性。方法：回顾性分析广西壮族自治区人民医院重症医学科 2022 年 1 月- 2024 年 12 月收治的110例接受 ECMO 串联 CRRT 治疗的患者数据。根据不同的抗凝方案将患者分为三组：单纯肝素（UFH）组（62 例）、UFH 联合局部枸橼酸（RCA）抗凝组（29 例）、UFH 联合甲磺酸萘莫司他（NM）抗凝组（19 例）。比较三组患者的 CRRT 管路凝血率、滤器寿命、出血风险、凝血指标及预后。结果：NM组患者基线APACHEⅡ评分30.43±6.58，高于其他两组（P=0.004），血小板水平91.19±93.15X109/L，低于其他两组（P=0.03）。三组间组管路凝血发生率（50.81% VS 58.24% VS 56.00%，P=0.48）及出血事件发生率无显著差异（40.32% VS 17.24% VS 21.05%，P=0.504），log-rank分析显示三组滤器寿命没有统计学差异（P=0.56）。与UFH组相比，UFH+NM组的D二聚体随时间上升速度显著慢于UFH组（P<0.0001），且下降幅度大于RCA组。三组患者的ICU生存率及住院时间没有统计学差异。结论：对于接受ECMO联合CRRT治疗的患者，若合并血小板减少症伴D二聚体显著升高，在UFH联合NM抗凝既未增加患者的出血风险，又可维持滤器有效寿命，是一种安全、有效的抗凝策略。 |
| 关键词: 体外膜肺氧合 连续肾脏替代治疗 甲磺酸萘莫司他 抗凝 |
| DOI： |
| 分类号: |
| 基金项目:广西医疗卫生适宜技术开发与推广应用项目(编号:s2022016)；广西壮族自治区疾病预防控制科技项目(编号:GXJKKJ2025ZD004) |
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| NM alongside systemic heparinization anticoagulation has been demonstrated to be both safe and effective for CRRT circuits |
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胡琨琳
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广西壮族自治区人民医院
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| Abstract: |
| Objective: This study aims to assess the safety and efficacy of combining unfractionated heparin (UFH) with Nafamostat Mesilate (NM) anticoagulation in continuous renal replacement therapy (CRRT) during extracorporeal membrane oxygenation (ECMO). Methods: A retrospective chart review was conducted for patients who underwent CRRT during ECMO between 2022 and 2024. Patients were categorized into three groups: the UFH group, the UFH plus regional citrate anticoagulation (RCA) group, and the UFH plus NM group. We assessed the filter lifespan, the rate of CRRT circuit clotting, coagulation parameters, and clinical outcomes. Results: Upon admission, the NM group demonstrated significantly higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (P=0.004) and lower baseline platelet counts (P=0.03) compared to the other groups. No statistically significant differences were observed among the three groups regarding premature CRRT discontinuation due to circuit clotting (<72 hours), filter lifespan, or overall bleeding incidence (P > 0.05). Linear mixed-effects modeling indicated that D-dimer levels in the NM group increased at a significantly slower rate over time than in the UFH group (P < 0.0001) and exhibited a greater reduction compared to the RCA group. |
| Key words: Extracorporeal membrane oxygenation Continuous renal replacement therapy Nafamostat mesilate Anticoagulation |
