本文選題：阿加曲班 + 普通肝素��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:對(duì)比阿加曲班和肝素在危重癥患者連續(xù)血液凈化(CBP)治療中的抗凝效果和安全性,優(yōu)化危重癥患者CBP治療的抗凝模式。方法:將天津醫(yī)科大學(xué)總醫(yī)院濱海醫(yī)院收治的40例CBP治療的患者分為觀察組(10例),對(duì)照組(30例)。觀察組采用阿加曲班(Argatorban)抗凝,對(duì)照組采用普通肝素(UFH)抗凝。CBP治療中監(jiān)測患者治療前,治療3小時(shí),治療結(jié)束前及治療結(jié)束后活化部分凝血酶時(shí)間(APTT);觀察管路及濾器凝血情況;觀察患者出血情況;監(jiān)測患者CBP前及連續(xù)CBP治療后血小板計(jì)數(shù)。結(jié)果:阿加曲班組和普通肝素(UFH)組在CBP治療后3小時(shí)和治療結(jié)束前APTT延長時(shí)間均有統(tǒng)計(jì)學(xué)意義(P0.05)。阿加曲班組治療結(jié)束后1小時(shí)APTT基本恢復(fù)正常(P0.05),而UFH組仍高于治療前(P0.05),兩組之間有統(tǒng)計(jì)學(xué)差異(P0.05)。阿加曲班組和UFH組管路及濾器的凝血評(píng)分比較無統(tǒng)計(jì)學(xué)意義(P0.05)。阿加曲班和UFH血液凈化治療后出血評(píng)分比較無統(tǒng)計(jì)學(xué)意義(P0.05)。阿加曲班和UFH血液凈化治療前血小板計(jì)數(shù)無明顯差異(P0.05),連續(xù)CBP治療5天后,肝素組血小板計(jì)數(shù)明顯低于阿加曲班組(P0.05),肝素組治療后較治療前明顯降低(P0.05)。結(jié)論:1.阿加曲班和肝素抗凝對(duì)比,管路及濾器的凝血評(píng)分無明顯差異。2.穿刺置管處出血評(píng)分無明顯差異。3.本次觀察發(fā)現(xiàn)肝素組能夠起到充分的抗凝作用,但在透析結(jié)束后1小時(shí)活化部分凝血酶時(shí)間(APTT)仍高于透析前,與透析前比較有意義。另外透析后血小板下降較為明顯,與治療前比較也有意義,故增加了后續(xù)出血的風(fēng)險(xiǎn)。4.本次觀察發(fā)現(xiàn)阿加曲班組亦能夠起到充分的抗凝作用,且在透析結(jié)束后1小時(shí)活化部分凝血酶時(shí)間即可恢復(fù)至透析前水平,與透析前比較沒有差異。另外透析后血小板計(jì)數(shù)下降亦不明顯,與治療前比較也沒有差異,降低了后續(xù)出血事件的發(fā)生。阿加曲班抗凝治療對(duì)活化部分凝血酶時(shí)間和血小板計(jì)數(shù)影響小。
[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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R459.7

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