甲磺酸萘莫司他与局部枸橼酸抗凝在高危出血风险患者连续性肾脏替代治疗中的对比：一项回顾性单中心研究。
Nafamostat mesylate versus regional citrate anticoagulation for continuous renal replacement therapy in patients at high risk of bleeding: a retrospective single-center study.
机构信息
Department of Emergency, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Yanchang Middle Road, Jingan District, Shanghai, People's Republic of China.
出版信息
Eur J Med Res. 2024 Jan 20;29(1):72. doi: 10.1186/s40001-024-01660-7.
PURPOSE
The choice of continuous renal replacement therapy (CRRT) anticoagulation program for patients at high risk of bleeding has always been a complex problem in clinical practice. Clinical regimens include regional citrate anticoagulation (RCA) and nafamostat mesylate (NM). This study aimed to evaluate the efficacy and safety of these two anticoagulants for CRRT in patients at high risk of bleeding to guide their clinical use better.
PATIENTS AND METHODS
Between January 2021 and December 2022, 307 patients were screened for this study. Forty-six patients were finally enrolled: 22 in the regional citrate anticoagulation group and 24 in the nafamostat mesylate group. We collected patients' baseline characteristics, laboratory indicators before CRRT, and CRRT-related data. We then performed a statistical analysis of the data from both groups of patients.
RESULTS
In our study, the baseline characteristics did not differ significantly between the two groups; the baseline laboratory indicators before CRRT of patients in the two groups were not significantly different. The duration of CRRT was 600 min in the regional citrate anticoagulation (RCA) group, 615 min in the nafamostat mesylate (NM) group; the success rate was 90.7% in the RCA group, and 85.6% in the NM group, the anticoagulant efficacy between the two groups was comparable. There was no significant difference in the safety of anticoagulation between the two groups. We used Generalized Estimating Equations (GEE) to test whether different anticoagulation methods significantly affected the success rate of CRRT and found no statistical difference between RCA and NM.
CONCLUSION
Our study suggests that nafamostat mesylate's anticoagulant efficacy and safety are not inferior to regional citrate anticoagulation for continuous renal replacement therapy in patients at high risk of bleeding.
目的
对于出血高危风险的患者，选择连续性肾脏替代治疗（CRRT）的抗凝方案一直是临床实践中的一个复杂问题。临床方案包括局部枸橼酸抗凝（RCA）和甲磺酸萘莫司他（NM）。本研究旨在评估这两种抗凝剂在出血高危风险的 CRRT 患者中的疗效和安全性，以更好地指导其临床应用。
方法
2021 年 1 月至 2022 年 12 月期间，对 307 例患者进行了筛选，最终纳入 46 例患者：22 例接受局部枸橼酸抗凝治疗，24 例接受甲磺酸萘莫司他治疗。我们收集了患者的基线特征、CRRT 前的实验室指标和 CRRT 相关数据，并对两组患者的数据进行了统计分析。
结果
在本研究中，两组患者的基线特征无显著差异；两组患者 CRRT 前的基线实验室指标无显著差异。局部枸橼酸抗凝（RCA）组的 CRRT 持续时间为 600 分钟，甲磺酸萘莫司他（NM）组为 615 分钟；RCA 组的成功率为 90.7%，NM 组为 85.6%，两组抗凝效果相当。两组的抗凝安全性无显著差异。我们使用广义估计方程（GEE）来检验不同的抗凝方法是否显著影响 CRRT 的成功率，发现 RCA 和 NM 之间没有统计学差异。
结论
本研究表明，甲磺酸萘莫司他在出血高危风险的患者中进行 CRRT 的抗凝效果和安全性不劣于局部枸橼酸抗凝。
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