对比在连续血液净化中阿加曲班和肝素抗凝疗效

发布时间：2018-06-16 21:04

本文选题：阿加曲班 + 普通肝素　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:对比阿加曲班和肝素在危重症患者连续血液净化(CBP)治疗中的抗凝效果和安全性,优化危重症患者CBP治疗的抗凝模式。方法:将天津医科大学总医院滨海医院收治的40例CBP治疗的患者分为观察组(10例),对照组(30例)。观察组采用阿加曲班(Argatorban)抗凝,对照组采用普通肝素(UFH)抗凝。CBP治疗中监测患者治疗前,治疗3小时,治疗结束前及治疗结束后活化部分凝血酶时间(APTT);观察管路及滤器凝血情况;观察患者出血情况;监测患者CBP前及连续CBP治疗后血小板计数。结果:阿加曲班组和普通肝素(UFH)组在CBP治疗后3小时和治疗结束前APTT延长时间均有统计学意义(P0.05)。阿加曲班组治疗结束后1小时APTT基本恢复正常(P0.05),而UFH组仍高于治疗前(P0.05),两组之间有统计学差异(P0.05)。阿加曲班组和UFH组管路及滤器的凝血评分比较无统计学意义(P0.05)。阿加曲班和UFH血液净化治疗后出血评分比较无统计学意义(P0.05)。阿加曲班和UFH血液净化治疗前血小板计数无明显差异(P0.05),连续CBP治疗5天后,肝素组血小板计数明显低于阿加曲班组(P0.05),肝素组治疗后较治疗前明显降低(P0.05)。结论:1.阿加曲班和肝素抗凝对比,管路及滤器的凝血评分无明显差异。2.穿刺置管处出血评分无明显差异。3.本次观察发现肝素组能够起到充分的抗凝作用,但在透析结束后1小时活化部分凝血酶时间(APTT)仍高于透析前,与透析前比较有意义。另外透析后血小板下降较为明显,与治疗前比较也有意义,故增加了后续出血的风险。4.本次观察发现阿加曲班组亦能够起到充分的抗凝作用,且在透析结束后1小时活化部分凝血酶时间即可恢复至透析前水平,与透析前比较没有差异。另外透析后血小板计数下降亦不明显,与治疗前比较也没有差异,降低了后续出血事件的发生。阿加曲班抗凝治疗对活化部分凝血酶时间和血小板计数影响小。
[Abstract]:Objective: to compare the anticoagulant effect and safety of agatoban and heparin in the treatment of critical patients with continuous blood purification (CBP), and to optimize the anticoagulant model of CBP in critically ill patients. Methods: 40 patients treated with CBP in Binhai Hospital of Tianjin Medical University were divided into observation group (n = 10) and control group (n = 30). The observation group was treated with Argatorbane, while the control group was treated with heparin, UFHH). CBP was used to monitor the blood coagulation of the patients before and after treatment. The activated partial thrombin time before and after the treatment was observed. To observe the bleeding and to monitor the platelet count before and after CBP treatment. Results: the prolongation time of APTT in Agatripine group and heparin UFH group was significantly different 3 hours after CBP treatment and before the end of treatment (P 0.05). APTT returned to normal at 1 hour after treatment in Agatripine group, while that in UFH group was still higher than that before treatment. There was a significant difference between the two groups (P 0.05). There was no significant difference in coagulation score between Agatripine group and UFH group (P 0.05). There was no significant difference in bleeding score between Agatripine and UFH after blood purification treatment (P 0.05). After 5 days of CBP treatment, the platelet count of heparin group was significantly lower than that of agatropan group (P 0.05), and heparin group was significantly lower than that of pre-treatment group (P 0.05). Conclusion 1. There was no significant difference in coagulation score between agatoban and heparin. There was no significant difference in bleeding score between puncture and catheterization. It was found that heparin group had sufficient anticoagulant effect, but the activated partial thrombin time (APTT) at 1 hour after dialysis was still higher than that before dialysis, which was significant compared with that before dialysis. In addition, thrombocytopenia after dialysis is more significant than before treatment, so increased the risk of subsequent bleeding. 4. It was found that the Agatripine group also had sufficient anticoagulant effect, and the activated partial thrombin time could return to the pre-dialysis level at 1 hour after dialysis, and there was no difference between the two groups. In addition, the platelet count was not significantly decreased after dialysis, and there was no difference compared with before treatment, which reduced the occurrence of subsequent bleeding events. Agatripine anticoagulant therapy had little effect on activated partial thrombin time and platelet count.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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