摘要
目的 研究新型抗凝剂甲磺酸萘莫司他在急诊连续性肾脏替代治疗(CRRT)中的应用价值.方法 采用回顾性分析,选取2021年6月至2023年1月入攀钢集团总医院的72例脓毒症伴发AKI患者为研究对象.所有患者均行连续性肾脏替代治疗(CRRT),参考是否接受甲磺酸萘莫司他体外抗凝分为研究组(n=36)与对照组(n=36).研究组接受甲磺酸萘莫司他体外抗凝,对照组未接受甲磺酸萘莫司他体外抗凝.比较两组患者治疗前、治疗72 h后的实验室指标[国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、血清钠、血清钙、血清钾、尿酸、半胱氨酸蛋白酶抑制剂C(CysC)、尿素氮、血清肌酐、血小板计数、血红蛋白]水平与治疗后滤器使用量、不良反应(过敏反应、高血钾、消化道症状、血小板下降、出血)发生率.结果 治疗72 h后,两组患者尿酸、CysC、尿素氮、血清肌酐、血小板计数、血红蛋白水平均明显低于治疗前,研究组患者治疗72 h后尿酸、CysC、尿素氮、血清肌酐水平分别为(86.41±15.24)μmol/L、(0.98±0.19)mg/L、(4.43±2.01)mmol/L、(99.32±15.61)μmol/L,均明显低于对照组[(105.29±20.43)μmol/L、(1.19±0.23)mg/L、(6.92±2.23)mmol/L、(127.54±20.47)μmol/L],差异均有统计学意义(P＜0.05).研究组患者治疗 72 h后滤器使用量为(1.29±0.47)个,明显少于对照组[(2.07±0.56)个],差异有统计学意义(P＜0.05).两组患者总不良反应发生率比较,差异无统计学意义(P＞0.05).结论 新型抗凝剂甲磺酸萘莫司他在急诊连续性肾脏替代治疗中的效果显著,可有效降低脓毒症伴发AKI患者的滤器更换频率,还可进一步改善其尿酸、CysC、尿素氮、血清肌酐水平,且未增大不良反应发生风险,安全性高.
Abstract
Objective To study the application value of a novel anticoagulant,naproxat mesylate in emergency continuous renal replace-ment therapy(CRRT).Methods The study method was retrospective analysis.The observation objects were 72 patients with sepsis with acute kidney injury(AKI)who were admitted to General Hospital of Shichen Panzhihua Steel Group form June 2021 to January 2023.All patients un-derwent continuous renal replacement therapy(CRRT),they were divided into the study group(n=36)and the control group(n=36)accord-ing to whether they received naproxat mesylate in vitro anticoagulation.The study group received naproxat mesylate in vitro anticoagulation,the control group did not receive naproxat mesylate in vitro anticoagulation.The levels of laboratory indicators[international normalized ratio(INR),activated partial thromboplastin time(APTT),serum sodium,serum calcium,serum potassium,uric acid,CystatinC(CysC),urea nitrogen,se-rum creatinine,platelet count,hemoglobin]before and after 72 hours of treatment,the number of filters used after treatment,the incidence rate adverse reactions(anaphylaxis,hyperkalemia,gastrointestinal symptoms,thrombocytopenia,bleeding)between the two groups were compared.Results After 72 hours of treatment,the levels of uric acid,CysC,urea nitrogen,serum creatinine,platelet count,and hemoglobin in both groups of patients were significantly lower than those before treatment,and the levels of uric acid,CysC,urea nitrogen,and serum creatinine after 72 hours of treatment in the study group were(86.41±15.24)μmol/L,(0.98±0.19)mg/L,(4.43±2.01)mmol/L,(99.32±15.61)μmol/L,respectively,which were significantly lower than those in the control group[(105.29±20.43)]µmol/L,(1.19±0.23)mg/L,(6.92±2.23)mmol/L,(127.54±20.47)μmol/L,the differences were statistically significant(P＜0.05).After 72 hours of treatment,the number of filters used in the study group was 1.29±0.47,which was significantly less than that in the control group(2.07±0.56),and the difference was statistically significant(P＜0.05).There was no statistically significant difference in the overall incidence of adverse reactions be-tween the two groups of patients(P＞0.05).Conclusion The novel anticoagulant naproxat mesylate has a significant effect in emergency con-tinuous renal replacement therapy,which can effectively reduce the filter replacement frequency of sepsis patients with AKI,further improve the levels of uric acid,CysC,urea nitrogen and serum creatinine,and does not increase the risk of adverse reactions,with high safety.
维普
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