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JAMA:局部枸橼酸盐vs全身肝素抗凝对持续肾脏替代治疗过滤器寿命及患者死亡率的影响

2020-10-28 MedSci原创 MedSci原创

在接受持续肾脏替代治疗的急性肾损伤危重患者中,与全身肝素抗凝相比,局部枸橼酸盐抗凝可显著延长过滤器寿命,但抗凝治疗对患者死亡率的影响差异不显著

目前的指南建议,在危重患者连续肾脏替代治疗中使用局部枸橼酸盐抗凝,即在体外透析回路过滤前向血液中添加柠檬酸盐溶液,但这一结论主要依据少量临床和荟萃分析的结果。近日研究人员比较了局部枸橼酸盐抗凝与全身肝素抗凝,对过滤器使用寿命和患者死亡率的影响。
 
本次研究在德国26个医疗中心开展。在596名需接受肾脏替代治疗的严重急性肾损伤或临床其他适应症的危重病人参与,患者随机接受局部枸橼酸盐抗凝(n=300),其目标电离钙水平为1.0至1.40 mg/dL,或全身肝素抗凝(n=296),其目标激活部分凝血活酶时间为45至60秒。研究的主要终点为过滤器寿命和90天死亡率。次要终点包括出血并发症和新感染
 
638名患者中,596名(93.4%)完成了试验(平均年龄67.5岁;183名女性)。局部枸橼酸盐组和全身肝素组相比较,平均过滤器寿命分别为47小时和26小时(差异:15小时)。局部枸橼酸盐组300例患者中150例90天内死亡,而在全身肝素抗凝组296例患者中156例死亡( 51.2% vs 53.6%;未经调整的差异为-2.4%;未调整的危险比为0.91;调整后的差异为-6.1%;调整后差异危险比:0.79)。在38个预先指定的次要终点中,34个没有显著差异。与全身肝素组相比,局部枸橼酸盐组出血并发症明显减少(5.1% vs 16.9%),新感染明显增多(68.0% vs 55.4%)。
 
研究认为,在接受持续肾脏替代治疗的急性肾损伤危重患者中,与全身肝素抗凝相比,局部枸橼酸盐抗凝可显著延长过滤器寿命,但抗凝治疗对患者死亡率的影响差异不显著。
 
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    2020-10-30 chg122
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    2020-10-28 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

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