甲磺酸萘莫司他在凝血功能障碍患者连续肾脏替代治疗中的应用研究

Study of the Application of Nafamostat Mesylate in Continuous Renal Replacement Therapy in Patients with Coagulation Dysfunction

摘要: 凝血功能障碍患者实施体外血液净化时，应用肝素常规抗凝，可增加消化道、肺和颅内出血等风险；应用枸橼酸体外抗凝，由于重症患者常合并肝肾功能不全，可导致枸橼酸蓄积、代谢性酸中毒等一系列并发症而受到限制；应用不抗凝方式，则可出现循环管路血栓和滤器使用时间缩短等不良事件。因此，在合并凝血功能障碍的危重症患者实施体外血液净化时，选择合适的抗凝方案至关重要。目前国内有少量文献报道指出，对于凝血功能障碍患者实施体外血液净化时选用甲磺酸萘莫司他进行体外抗凝。甲磺酸萘莫司他是一种分子量较小、作用时间短的抗凝剂，它在体外循环回路中发挥抗凝作用，同时在体内迅速失活，在体外循环回路中抗凝，较其他传统抗凝剂具有出血并发症低、易于机体清除和便于管理等优势，已在日本应用30余年。而在中国和欧美等国家中，甲磺酸萘莫司他应用于体外血液净化抗凝的临床报道较少，相关研究文献较少。本文从甲磺酸萘莫司他的作用机制、临床应用、监测方法和不良反应等方面进行综述，阐明甲磺酸萘莫司体外抗凝的优越性及安全性，为凝血功能障碍患者实施体外血液净化提供抗凝新方案。

Abstract: When patients with coagulation dysfunction undergo extracorporeal blood purification, routine an-ticoagulation with heparin may increase the risk of gastrointestinal, pulmonary and intracranial hemorrhage; the application of citrate in vitro anticoagulation is limited, because severe patients often combined with liver and kidney dysfunction, which can lead to a series of complications such as citric acid accumulation and metabolic acidosis; with non-anticoagulation, adverse events such as circulate thrombosis and reduced filter use time may occur. Therefore, it is important to select an appropriate anticoagulation when performing extracorporeal blood purification in critically ill pa-tients with coagulation dysfunction. At present, a small number of domestic literature reports point out that nafmostat mesylate is selected for extracorporeal anticoagulation when purifying blood in vitro in patients with coagulation dysfunction. Nafmostat mesylate is an anticoagulant with small molecular weight and short action time, it plays an anticoagulant role in the extracorporeal circu-late, and at the same time is rapidly inactivated in the body, anticoagulation in the extracorporeal circulation circuit, and has the advantages of low bleeding complications, easy body clearance and easy management than other traditional anticoagulants, and has been used in Japan for more than 30 years. In China, Europe and the United States and other countries, there are fewer clinical re-ports of namostat mesylate in vitro blood purification and anticoagulation, and there are few relat-ed research literature. This article reviews the mechanism, clinical application, monitoring methods and adverse reactions of nafmostat mesylate, clarifies the superiority and safety of nacrostimus mesylate in vitro anticoagulation, and provides a new anticoagulation scheme for patients with co-agulation dysfunction to purify extracorporeal blood.