古力尼沙汗·如孜,王宝珠,凯丽曼·阿布都米吉提,阿迪拉·阿扎提

• 1:新疆医科大学第一临床医学院心内科

摘要(Abstract)：

目的 对比研究肝素与比伐芦定在接受静脉-动脉体外膜肺氧合（VA-ECMO）辅助患者中的抗凝安全性和有效性。方法 回顾性研究2017年12月至2021年7月在新疆医科大学第一临床医学院接受VA-ECMO辅助至少24 h的患者。按ECMO辅助期间的抗凝方案分为肝素组和比伐芦定组。比较两组患者血栓事件、出血事件、继发性血小板减少的发生情况，血制品的输注情况，以及重症监护室监护时间和住院期间死亡率，进而比较比伐芦定与肝素在临床VA-ECMO辅助期间的抗凝安全性和有效性。同时比较两组患者住院期间的抗凝药物费用和住院总费用。结果最终纳入40例患者为研究对象，肝素组26例，比伐芦定组14例。比伐芦定组D-二聚体水平高于肝素组[516.000(223.000,763.500)ng/ml比252.500(97.250,407.750)ng/ml,P=0.045]，余基线资料两组患者之间有不同程度的差异，但差异均无统计学意义（均P>0.05）。肝素组患者血栓事件发生率[46.15%(12/26)比7.14%(1/14),P=0.031]、肝素诱导的血小板减少发生率[34.62%(9/26)比0.00(0/14),P=0.016]均高于比伐芦定组。比伐芦定组患者血浆输注（P=0.017）、抗凝药物费用（P<0.001）均高于肝素组患者。但两组患者之间是否成功撤机、院内死亡率、重症监护室监护时间、出血事件的发生率、红细胞输注、血小板输注、冷沉淀输注情况及住院总费用等方面的差异均无统计学意义（均P>0.05）。比伐芦定组患者的术后活化部分凝血酶时间及活化凝血时间监测值较肝素组患者更平稳地波动在目标值范围及附近。结论 成人VAECMO辅助期间使用比伐芦定较肝素更能降低患者血栓事件及继发性血小板减少发生率，较肝素更有效且安全性更高；尽管比伐芦定药物费用高于肝素，但不增加患者住院总费用；比伐芦定较肝素更易于抗凝监测管理。

关键词(KeyWords)： 体外膜肺氧合;肝素;比伐芦定

Abstract:

Keywords:

基金项目(Foundation): 优秀青年人才科研启动金项目（新医大一附院院字[2020]63号）

作者(Author): 古力尼沙汗·如孜,王宝珠,凯丽曼·阿布都米吉提,阿迪拉·阿扎提

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