阿加曲班与普通肝素在重度心肺功能不全患者体外膜肺氧合治疗中的抗凝比较及临床评价
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摘要
目的通过研究阿加曲班与普通肝素在重度心肺功能不全患者体外膜肺氧合治疗(ECMO)中的抗凝作用,比较2种药物疗效及不良反应,评价阿加曲班的抗凝效果及安全性。方法回顾性分析我院2016年1月至2018年12月40例ECMO患者,按照当时ECMO抗凝方式不同分为普通肝素(Hep)组25例和阿加曲班(Arg)组20例。比较住院期间血小板(PLT)计数,血液流变学、血凝指标及并发出血疾病、穿刺部位并发症、泵管凝血程度情况和膜肺使用寿命。结果 2组患者血液流变学、血凝指标治疗后24及48 h较治疗前差异有统计学意义(P<0.05);而Arg组血液流变学较Hep组降低更明显(P<0.05),血小板计数显著高于Hep组(P<0.05);膜肺,泵及管路凝血程度评分明显降低(P<0.05);出血和穿刺部位不良情况明显降低(P<0.05),膜肺使用寿命显著延长。结论 Arg在重度心肺功能不全患者ECMO治疗中有良好的抗凝疗效,对血小板计数无影响,发生不良事件少,使膜肺使用寿命延长。
Objective To study the clinical effect of argatroban and efficacy and heparin in patients with severe respiratory insufficiency during the ECMO, to compare efficacy and adverse reactions of two drugs, to evaluate the anticoagulant effect and safety. Methods Forty ECMO patients in our hospital from January 2016 to December2018 were retrospectively analyzed. According to the different anticoagulation methods of ECMO, they were divided into heparin group(25 cases) and argatroban group(20 cases). The PLT count, hemorheology, coagulation index, hem-orrhage, complications of puncture site, coagulation degree of pump tube and life of membranous lung were observed and compared during hospitalization. Results The hemorheology and hemagglutination indexes of the two groups were significantly different 24 and 48 hours after treatment than before treatment(P<0.05). However, hemorheology in Arg group was significantly lower than that in Hep group(P<0.05), PLT count was significantly higher than that in Hep group(P<0.05). The score of coagulation degree of membranous lung, pump and pipeline decreased significantly(P<0.05). Bleeding and adverse puncture site conditions were significantly reduced(P<0.05), and membrane lung life was significantly prolonged. Conclusion Argatroban has good anticoagulant effect in ECMO treatment of patients with severe cardiopulmonary insufficiency, no effect on platelet count and few adverse events. And it could prolong the service life of membranous lung.
Objective To study the clinical effect of argatroban and efficacy and heparin in patients with severe respiratory insufficiency during the ECMO, to compare efficacy and adverse reactions of two drugs, to evaluate the anticoagulant effect and safety. Methods Forty ECMO patients in our hospital from January 2016 to December2018 were retrospectively analyzed. According to the different anticoagulation methods of ECMO, they were divided into heparin group(25 cases) and argatroban group(20 cases). The PLT count, hemorheology, coagulation index, hem-orrhage, complications of puncture site, coagulation degree of pump tube and life of membranous lung were observed and compared during hospitalization. Results The hemorheology and hemagglutination indexes of the two groups were significantly different 24 and 48 hours after treatment than before treatment(P<0.05). However, hemorheology in Arg group was significantly lower than that in Hep group(P<0.05), PLT count was significantly higher than that in Hep group(P<0.05). The score of coagulation degree of membranous lung, pump and pipeline decreased significantly(P<0.05). Bleeding and adverse puncture site conditions were significantly reduced(P<0.05), and membrane lung life was significantly prolonged. Conclusion Argatroban has good anticoagulant effect in ECMO treatment of patients with severe cardiopulmonary insufficiency, no effect on platelet count and few adverse events. And it could prolong the service life of membranous lung.
引文
[1]Koster A,Faraoni D,Levy JH.Argatroban and bivalirudin for perioperative anticoagulation in cardiac surgery[J].Anesthesiology,2018,128(2):390-400.
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[6]Berekashvili K,Soomro J,Shen L,et al.Safety and feasibility of argatroban,recombinant tissue plasminogen activator,and intra-arterial therapy in stroke(ARTSS-IA Study)[J].J Stroke Cerebrovasc Dis,2018,27(12):3647-3651.
[7]Hirasaki Y,Yamamoto Y,Nakamura T,et al.Rotational thromboelastometry for coagulation management during cardiopulmonary bypass using argatroban[J].J Cardiothorac Vasc Anesth,2018,9(25):1021-1029.
[8]Sklar MC,Sy E,Lequier L,et al.Anticoagulation practices during venovenous extracorporeal membrane oxygenation for respiratory failure.A systematic review[J].Ann Am Thorac Soc,2016,13(12):2242-2250.
[9]Rouge A,Pelen F,Durand M.Argatroban for an alternative anticoagulant in HIT during ECMO[J].J Intensive Care,2017,5:39.
[10]Menk M,Briem P,Weiss B,et al.Efficacy and safety of argatroban in patients with acute respiratory distress syndrome and extracorporeal lung support[J].Ann Intensive Care,2017,7(1):82-91.
[11]Bulani Y,Sharma SS.Argatroban attenuates diabetic cardiomyopathy in rats by reducing fibrosis,inflammation,apoptosis,and protease-activated receptor expression[J].Cardiovasc Drugs Ther,2017,31(3):255-267.
[2]Braune S,Sieweke A,Jarczak D,et al.Extracorporeal lung support[J].Med Klin Intensivmed Notfmed,2016,112(5):426-436.
[3]Beiderlinden M,Brau C,di Grazia S,et al.Argatroban for anticoagulation of a blood salvage system-an ex-vivo study[J].BMC Anesthesiol,2016,16(1):37-45.
[4]Kim YS,Lee H,Yang JH,et al.Use of argatroban for extracorporeal life support in patients with nonheparin-induced thrombocytopenia:analysis of 10 consecutive patients[J].Medicine(Baltimore),2018,97(47):e13235.
[5]Zhang L,Yang J,Zheng X,et al.Influences of argatroban on five fibrinogen assays[J].Int J Lab Hematol,2017,39(6):641-644.
[6]Berekashvili K,Soomro J,Shen L,et al.Safety and feasibility of argatroban,recombinant tissue plasminogen activator,and intra-arterial therapy in stroke(ARTSS-IA Study)[J].J Stroke Cerebrovasc Dis,2018,27(12):3647-3651.
[7]Hirasaki Y,Yamamoto Y,Nakamura T,et al.Rotational thromboelastometry for coagulation management during cardiopulmonary bypass using argatroban[J].J Cardiothorac Vasc Anesth,2018,9(25):1021-1029.
[8]Sklar MC,Sy E,Lequier L,et al.Anticoagulation practices during venovenous extracorporeal membrane oxygenation for respiratory failure.A systematic review[J].Ann Am Thorac Soc,2016,13(12):2242-2250.
[9]Rouge A,Pelen F,Durand M.Argatroban for an alternative anticoagulant in HIT during ECMO[J].J Intensive Care,2017,5:39.
[10]Menk M,Briem P,Weiss B,et al.Efficacy and safety of argatroban in patients with acute respiratory distress syndrome and extracorporeal lung support[J].Ann Intensive Care,2017,7(1):82-91.
[11]Bulani Y,Sharma SS.Argatroban attenuates diabetic cardiomyopathy in rats by reducing fibrosis,inflammation,apoptosis,and protease-activated receptor expression[J].Cardiovasc Drugs Ther,2017,31(3):255-267.