目的 研究抗凝血酶Ⅲ活性下降患者連續(xù)性腎臟替代（CRRT）治療中分別采用阿加曲班與肝素抗凝的效果及安全性。方法 回顧性選擇徐州市腫瘤醫(yī)院2019年5月一2020年11月期間收治的抗凝血酶Ⅲ活性減低的CRRT患者120例為研究對(duì)象，根據(jù)患者自愿選擇治療方案將其分為阿加曲班組（n=58）和肝素組（n=62）。阿加曲班組采用阿加曲班作為抗凝劑，肝素組采用普通肝素作為抗凝劑。兩組患者分別于CRRT治療前、治療中（透析后2 h）、治療結(jié)束后1h觀察凝血酶原時(shí)間（PT）、活化部分凝血酶時(shí)間（APTT）、肌酐（Cr）、尿素氮（BUN）、白細(xì)胞介素-6（IL-6）水平、腫瘤壞死因子-α（TNF-α）水平，并于治療過(guò)程中觀察濾器及管路凝血情況，統(tǒng)計(jì)血濾器使用壽命和出血并發(fā)癥發(fā)生率。結(jié)果 阿加曲班組CRRT治療后PT、APTT水平明顯低于肝素組（P<0.05）；阿加曲班組CRRT治療后Cr、BUN、IL-6、TNF-α水平明顯低于肝素組（P<0.05）。阿加曲班組CRRT治療后凝血分級(jí)0級(jí)和Ⅰ級(jí)的患者占比多于肝素組（P<0.05），阿加曲班組血濾器使用壽命均高于肝素組（P<0.05），阿加曲班組CRRT治療后出血并發(fā)癥發(fā)生率為3.45%，低于肝素組19.35%（P<0.05）。結(jié)論 CRRT治療抗凝血酶Ⅲ活性下降的患者使用阿加曲班抗凝效果優(yōu)于肝素，且能延長(zhǎng)血濾器使用壽命，進(jìn)而提高CRRT對(duì)毒素和炎癥因子清除效率，降低出血事件發(fā)生率。

Objective To study the anticoagulant effect and safety of argatroban and heparin in patients with decreased thrombin Ⅲ activity treated by continuous renal replacement therapy(CRRT).Methods A retrospective selection of 120 patients with decreased thrombin Ⅲ activity treated by CRRT admitted to Xuzhou Cancer Hospital from May 2019 to November 2020 were divided into argatroban group(n=58) and heparin group(n=62) based on the patients' voluntary choice of treatment plan.Agatroban was used as anticoagulant in agatroban group, and heparin was used as anticoagulant in heparin group.The prothrombin time(PT), activated partial thrombin time(APTT), creatinine(Cr), urea nitrogen(BUN), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) levels of patients in the two groups were observed before, during(two hours) and after(one hour) CRRT treatment.In the course of treatment, the coagulation of the filter and pipeline was observed, and the service life of the filter and the incidence of bleeding complications were counted.Results The levels of PT, APTT after CRRT treatment in the argatroban group were significantly lower than those in the heparin group(P<0.05).The levels of Cr, BUN, IL-6, TNF-α after CRRT treatment in the argatroban group were significantly lower than those of the heparin group(P<0.05).The percentage of patients with coagulation grade 0 and grade I after CRRT treatment in argatroban group was higher than that in heparin group(P<0.05).The service life of hemofilter in argatroban group was higher than that in heparin group(P<0.05).The incidence of bleeding complications after CRRT treatment in argatroban group was 3.45%, lower than that in heparin group(19.35%, P<0.05).Conclusion The anticoagulant effect of argatroban on patients with decreased thrombinⅢ activity treated by CRRT is better than heparin, and it can prolong the service life of the hemofilter, thereby increasing the efficiency of CRRT to remove toxins and inflammatory factors, and reducing the incidence of bleeding events.

R973