华西医学

华西医学

甲磺酸萘莫司他在连续性肾脏替代治疗中的抗凝应用

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在日本的重症监护病房中,连续性血液净化疗法最常用的抗凝剂是甲磺酸萘莫司他(nafamostat mesilate,NM),比例达到了 85%。其最大的特点是即使对具有高出血风险的患者群进行治疗也不会使滤器寿命缩短,可以安全使用。但是,也有报告称 NM 出现过不少严重的过敏反应,一般认为连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)开始后的过敏症状是 NM 过敏症。另外,由于药剂的价格昂贵,因此建议仅在出现严重出血性并发症风险的病例中使用。因为已临床使用近 30 年,所以 NM 在日本 CRRT 抗凝中获得很高的信赖。但是,在国际上,对有严重出血性并发症风险的病例,一般推荐使用局部枸橼酸抗凝。为证明 NM 抗凝的确实有效性,有必要进行与局部枸橼酸抗凝的随机对照试验。

In the intensive care units of Japan, nafamostat mesilate (NM) is the most used anticoagulant of continuous blood purification, with the rate of up to 85%. Its biggest characteristic is not to reduce the life of the filter in the group of patients with high risk of bleeding, and it can be safely used. However, there are not a few reports about severe anaphylaxis, when the symptoms of anaphylaxis is recognized after the start of continuous renal replacement therapy, it should be kept in mind that it is NM hypersensitivity. In addition, for an expensive drug, it may be required to be limited in the cases of risk of bleeding complications. NM has been developed for nearly 30 years, so it has high reliability in Japan. However, in the same case, regional citrate anticoagulation is recommended internationally. It may need a randomized controlled trial with regional citrate anticoagulation to prove the real effectiveness of NM.

关键词: 甲磺酸萘莫司他; 抗凝剂; 出血性并发症; 活化凝血时间; 滤器寿命; 枸橼酸

Key words: Nafamostat mesilate; Anticoagulant; Bleeding complication; Activated clotting time; Filter life time; Citrate

引用本文: 北村伸哉. 甲磺酸萘莫司他在连续性肾脏替代治疗中的抗凝应用. 华西医学, 2018, 33(7): 801-805. doi: 10.7507/1002-0179.201806036 复制