甲磺酸萘莫司他在重症患者CRRT与ECMO中抗凝应用的研究进展

Anticoagulation application of Nafamostat Mesylate in critically ill patients received continuous renal replacement therapy and extracorporeal membrane oxygenation

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摘要近年来,随着医学进步,体外生命支持技术已然成为重症患者治疗的常规手段,比如连续性肾脏替代治疗(CRRT)、体外膜肺氧合(ECMO)等。有效的抗凝和较少的出血并发症是体外生命支持中亟需解决的主要矛盾。目前,普通肝素仍然是最常用的抗凝剂。然而,与全身肝素化相关的出血仍是体外抗凝治疗中的主要并发症,直接关系到患者的预后。为了降低治疗期间的出血风险,各种改良的抗凝技术相继出现。甲磺酸萘莫司他(NM)是一种人工合成的超短效丝氨酸蛋白酶抑制剂,可以通过灭活凝血酶、抑制凝血因子激活起到抗凝的作用。NM似乎可以在不增加血栓栓塞的同时降低出血的发生率。本文在现有文献报告的基础上,总结NM在重症患者CRRT和ECMO中的抗凝应用,以期为治疗期间的抗凝管理提供参考。 In recent years,with the advancement of medical,extracorporeal life support technology has become an important strategy for critically ill patients,such as continuous renal replacement therapy(CRRT),extracorporeal membrane oxygenation(ECMO),etc.Effective anticoagulation and less bleeding complications are the main contradictions that need to be solved urgently during extracorporeal life support.Currently,unfractionated heparin remains the most commonly used for anticoagulation.However,hemorrhage associated with systemic heparinization remains a major complication and is directly related to patient outcomes.Various improved anticoagulation techniques have been used to reduce the risk of bleeding.Nafamostat Mesylate(NM)is a synthetic ultra-short-acting serine protease inhibitor,which can play an anticoagulant role by inactivating thrombin and inhibiting the activation of coagulation factors.Evidences show that NM can reduce the incidence of bleeding without increasing the incidence of thromboembolism.We aim to summarize the anticoagulation application of NM in CRRT and ECMO in critically ill patients on the basis of existing literature reports,in order to provide reference for the anticoagulation management during treatment.

作者高学慧邹晓静杨小博尚游 Gao Xuehui;Zou Xiaojing;Yang Xiaobo;Shang You(Department of Critical Care Medicine,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Institute of Anesthesiology and Critical Care Medicine,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区华中科技大学同济医学院附属协和医院重症医学科华中科技大学同济医学院附属协和医院麻醉与危重症研究所

出处《中华重症医学电子杂志》 CSCD 2023年第2期210-216,共7页 Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基金国家自然科学基金项目(81971818)

关键词甲磺酸萘莫司他抗凝剂连续性肾脏替代治疗体外膜肺氧合出血性并发症 Nafamostat Mesilate Anticoagulant Continuous renal replacement therapy Extracorporeal membrane oxygenation Bleeding complication

分类号 R47 [医药卫生—护理学]

作者简介通信作者:尚游,Email:you_shanghust@163.com