中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (07): 590-593.doi: 10.3969/j.issn.1671-4091.2025.07.010

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休克合并组织低灌注伴高危出血风险患者连续性肾脏替代治疗的抗凝药物研究进展

宋春    李 荣    唐思妍    汤思微    柏 明    张 鹏   

  1. 710068 西安，1西安医学院研究生院
    710032 西安，2空军军医大学西京医院肾脏内科
    710068 西安，3陕西省人民医院肾脏内科
  • 收稿日期:2025-02-11 修回日期:2025-03-10 出版日期:2025-07-12 发布日期:2025-07-12
  • 通讯作者: 张鹏 E-mail:zhangpeng@fmmu.edu.com
  • 基金资助:
    国家自然科学基金(82070699)

Research progress in the use of anticoagulants during continuous renal replacement therapy for shock patients with low tissue perfusion and high risk of bleeding

ONG Chun-yan, LI Rong, TANG Si-yan, TANG Si-wei, BAI Ming, ZHANG Peng   

  1. Graduate School of Xi'an Medical University, Xi'an 710068, China; 2Department of Nephrology, Xijing Hospital, Air Force Military Medical University, Xi'an 710032, China; 3Department of Nephrology, Shanxi Provincial People's Hospital, Xi'an 710068, China
  • Received:2025-02-11 Revised:2025-03-10 Online:2025-07-12 Published:2025-07-12
  • Contact: 西安 710068，3陕西省人民医院肾脏内科 E-mail:zhangpeng@fmmu.edu.com

摘要： 连续性肾脏替代治疗(continuous renal replacement treatment,CRRT)作为急性肾损伤(acute kidney injury,AKI)，尤其是休克合并组织低灌注患者常见的治疗手段，能够有效清除患者体内各种毒物，维持水、电解质平衡，还能改善血流动力学稳定。然而，由于CRRT过程中血液的持续循环和滤过，血栓形成的风险显著增加，因此抗凝变得尤为必要。在休克合并组织低灌注伴高危出血风险的患者中，抗凝策略尤为复杂，既要考虑抗凝药物的效果，又要平衡患者的出血风险和血栓形成风险。因此笔者将对临床上常用的无抗凝、枸橼酸盐、甲磺酸萘莫司他和阿加曲班等抗凝方案在休克合并组织低灌注伴高危出血风险患者CRRT治疗中的可行性和安全性进行概述。

关键词: 连续性肾脏替代治疗, 休克合并组织低灌注, 高危出血风险, 抗凝

Abstract: Continuous renal replacement therapy (CRRT) is a common treatment for acute kidney injury (AKI), especially for patients with shock and tissue hypoperfusion. CRRT can effectively remove various kinds of toxins, maintain the balance of water and electrolytes, and stabilize hemodynamics in these patients. However, due to the continuous blood circulation and filtration during CRRT, the risk of thrombosis is increased, and anticoagulation is therefore necessary. Anticoagulation strategy is particularly complex in patients with shock combined with tissue hypoperfusion and high risk of bleeding, which needs to consider the balance between the effect of anticoagulants and the risks of bleeding and thrombosis. In this article the authors summarize the feasibility and safety of non-anticoagulation, citrate, nafamostat mesylate, argatroban and other common anticoagulation regimens used in CRRT for shock patients with low tissue perfusion and high risk of bleeding.

Key words: Continuous renal replacement therapy, Shock with tissue hypoperfusion, High risk of bleeding, Anticoagulation

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