目的 研究抗凝血酶Ⅲ活性下降患者连续性肾脏替代（CRRT）治疗中分别采用阿加曲班与肝素抗凝的效果及安全性。方法 回顾性选择徐州市肿瘤医院2019年5月一2020年11月期间收治的抗凝血酶Ⅲ活性减低的CRRT患者120例为研究对象，根据患者自愿选择治疗方案将其分为阿加曲班组（n=58）和肝素组（n=62）。阿加曲班组采用阿加曲班作为抗凝剂，肝素组采用普通肝素作为抗凝剂。两组患者分别于CRRT治疗前、治疗中（透析后2 h）、治疗结束后1h观察凝血酶原时间（PT）、活化部分凝血酶时间（APTT）、肌酐（Cr）、尿素氮（BUN）、白细胞介素-6（IL-6）水平、肿瘤坏死因子-α（TNF-α）水平，并于治疗过程中观察滤器及管路凝血情况，统计血滤器使用寿命和出血并发症发生率。结果 阿加曲班组CRRT治疗后PT、APTT水平明显低于肝素组（P<0.05）；阿加曲班组CRRT治疗后Cr、BUN、IL-6、TNF-α水平明显低于肝素组（P<0.05）。阿加曲班组CRRT治疗后凝血分级0级和Ⅰ级的患者占比多于肝素组（P<0.05），阿加曲班组血滤器使用寿命均高于肝素组（P<0.05），阿加曲班组CRRT治疗后出血并发症发生率为3.45%，低于肝素组19.35%（P<0.05）。结论 CRRT治疗抗凝血酶Ⅲ活性下降的患者使用阿加曲班抗凝效果优于肝素，且能延长血滤器使用寿命，进而提高CRRT对毒素和炎症因子清除效率，降低出血事件发生率。

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