Abstract:

Objective　To explore the anticoagulant effect and safety of different dosages of nafamostat mesylate for patients taking hemodialysis. Methods　According to the dosages of nafamostat mesylate, the patients were divided into a 10 mg/h nafamostat mesilate group (33 cases), including 23 males and 10 females who were (58.8±16.0) years old, and a 20 mg/h nafamostat mesilate group (32 cases), including 17 males and 15 females who were (62.6±15.7) years old. All the patients took hemodialysis for 4 h per time, 3 times per week. The data were compared between the two groups by independent-sample t test or non-parameter test. The rates of venous clotting, artery clotting, and cumulative catheter blockage were compared between the two groups by Kaplan-Meier survival analysis and log-rank test. Results　A total of 65 patients undergoing maintenance dialysis were included; they underwent 178 case times of nafamostat mesilate anticoagulation, including 87 case times in the 10 mg/h nafamostat mesilate group and 91 case times in the 20 mg/h nafamostat mesilate group. There were no statistical differences in gender, age, body weight, height, coronary heart disease, diabetes mellitus, bleeding causes, and laboratory indicators between the two groups (P>0.05). More patients had venous clotting score of 3 in the 10 mg/h nafamostat mesilate group than in the 20 mg/h nafamostat mesilate group [6.9% (6/87) vs. 3.3% (3/91)], with a statistical difference (P<0.05). The treatment time in the 20 mg/h nafamostat mesilate group was longer than that in the 10 mg/h nafamostat mesilate group [(225.0±21.3) min vs. (217.0±18.1) min], with a statistical difference (t=-2.587; P<0.05). The pre-dialysis transmembrane pressure and arterial pressure in the 20 mg/h nafamostat mesilate group were significantly lower than those in the 10 mg/h nafamostat mesilate group [(57.0±43.4) mmHg (1 mmHg=0.133 kPa) vs. (77.3±31.2) mmHg and (-82.3±28.9) mmHg vs. (-71.1±29.4) mmHg], with statistical differences (t=3.488 and 2.448; both P<0.05). The survival analysis showed that there was no statistical difference in the catheter blockage rate between the two groups (P>0.05). After anticoagulation with nafamostat mesilate, 2 cases (3.1%) experienced aggravated bleeding in the 65 patients. Conclusion　Anticoagulation with nafamostat mesilate in standard hemodialysis treatment has a low incidence of venous clotting occlusion and minor bleeding risk. The 20 mg/h dosage of nafamostat mesilate exhibits better effectiveness, can reduce the rate of venous clotting and offer a new anticoagulation method for patients taking maintenance dialysis at high risk of bleeding.

Key words:

Hemodialysis, Nafamostat mesylate, Anticoagulant, Venous clotting

摘要：

目的　探讨不同剂量甲磺酸萘莫司他在血液透析治疗中的抗凝效果与安全性。方法　前瞻性队列研究。选取2023年3月至8月在广东省人民医院血液净化中心行甲磺酸萘莫司他抗凝治疗的65例维持性透析患者作为研究对象，根据患者接受甲磺酸萘莫司他抗凝剂量分为萘莫司他10 mg/h组（33例）和萘莫司他20 mg/h组（32例）。萘莫司他10 mg/h组男23例、女10例，年龄（58.8±16.0）岁；萘莫司他20 mg/h组男17例、女15例，年龄（62.6±15.7）岁。所有患者均采用血液透析治疗模式，每周3次，治疗时间每次4 h。组间比较采用独立样本t检验或非参数检验，采用Kaplan-Meier生存分析和log-rank检验比较两组静脉壶、动脉壶和管路堵塞率组间差异。结果　共纳入65例维持性透析患者，行甲磺酸萘莫司他抗凝178例次，其中萘莫司他10 mg/h组87例，萘莫司他20 mg/h组91例。两组患者性别、年龄、干体质量、身高、冠心病、糖尿病、出血原因及实验室检查指标比较，差异均无统计学意义（均P>0.05）。萘莫司他20 mg/h组静脉壶堵塞评分为3分的患者占3.3%（3/91），低于萘莫司他10 mg/h组的6.9%（6/87），差异有统计学意义（P<0.05）。萘莫司他20 mg/h组治疗时间长于萘莫司他10 mg/h组［（225.0±21.3）min比（217.0±18.1）min］，差异有统计学意义（t=-2.587，P<0.05）。萘莫司他20 mg/h组透前跨膜压和透前动脉压均低于萘莫司他10 mg/h组［（57.0±43.4）mmHg（1 mmHg=0.133 kPa）比（77.3±31.2）mmHg、（-82.3±28.9）mmHg比（-71.1±29.4）mmHg］，差异均有统计学意义（t=3.488、2.448，均P<0.05）。生存分析显示，两组患者体外循环累积堵管率比较，差异无统计学意义（P>0.05）。65例维持性透析患者使用萘莫司他抗凝后，2例（3.1%）发生出血加重情况。结论　甲磺酸萘莫司他抗凝在普通血液透析治疗中堵管发生率较低，出血风险小。20 mg/h的萘莫司他抗凝具有更好效果，可以显著降低静脉壶堵塞发生率，为出血高风险的维持性透析患者提供新的抗凝方法。

关键词:

血液透析, 甲磺酸萘莫司他, 抗凝, 静脉壶堵塞