Clinical experience with nadroparin in patients undergoing dialysis for renal impairment
Clinical experience with nadroparin in patients undergoing dialysis for renal impairment
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那屈肝素用于肾功能不全透析患者的临床经验
DOI：
10.1111/j.1542-4758.2011.00564.x
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发表时间：
2011
影响因子：
1.3
通讯作者：
N. Chen
中科院分区：
文献类型：
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作者：
Wen Zhang;Xiao;Yong Chen;N. Chen
透析程序是维持生命的肾脏替代疗法，适用于肾功能受限或无肾功能的患者。透析过程中体外回路中形成凝块是一种不良事件。因此，在这种情况下常规进行抗凝治疗。普通肝素（UFH）主要用于透析患者。然而，除了出血风险升高的患者外，2002年欧洲血液透析最佳实践指南专家组建议使用低分子量肝素，而不是UFH，因为它们具有相同的疗效，更高的安全性和易于处理。低分子量肝素由几种药物组成，在许多药理学和临床特性方面存在差异。本手稿回顾了那屈肝素（一种在透析患者中广泛研究的低分子量肝素）获得的数据。因此，几项研究在接受间歇性血液透析的患者中研究了那屈肝素与UFH、其他低分子量肝素或柠檬酸盐相比的获益。总体而言，他们表明，在终末期肾衰竭成人和儿童中，根据体重调整的那屈肝素单次静脉推注剂量在持续长达6小时的间歇性血液透析期间维持体外回路通畅性是有效和安全的。与UFH相比，由于那屈肝素给药后的抗凝反应可靠，因此不需要对抗凝活性进行实验室监测。与UFH相比，那屈肝素在脂质和可能的骨参数方面有益。在接受连续性肾脏替代治疗治疗急性肾衰竭的患者中，那屈肝素推注给药，然后连续输注也显示出有效和安全性。
Dialysis procedures are life‐sustaining renal replacement therapies indicated for patients with limited or no kidney function. The formation of clots in the extracorporeal circuit during dialysis is an undesirable event. Anticoagulation is therefore routinely practiced in this context. Unfractionated heparin (UFH) is largely used in dialysis patients. However, except in patients with an elevated risk of bleeding, the 2002 European Best Practice Guidelines Expert Group on Hemodialysis recommended the use of low–molecular‐weight heparins over UFH, in view of their equal efficacy, improved safety, and easy handling. Low–molecular‐weight heparins comprise several drugs, differing in a number of pharmacological and clinical properties. This manuscript reviews the data obtained with nadroparin, a low–molecular‐weight heparin studied extensively in dialysis patients. Thus, several studies investigated the benefit of nadroparin vs. UFH, other low–molecular‐weight heparins, or citrate in patients undergoing intermittent hemodialysis. Overall, they showed that a single intravenous bolus dose of nadroparin, adjusted according to body weight, was effective and safe for maintaining the patency of the extracorporeal circuit during intermittent hemodialysis sessions lasting up to 6 hours, in both adults and children with end‐stage renal failure. In contrast to UFH, nadroparin required no laboratory monitoring of anticoagulant activity owing to the reliable anticoagulant response following its administration. Compared with UFH, nadroparin was beneficial in terms of lipid and possibly bone parameters. Nadroparin administered by a bolus dose, followed by a continuous infusion was also shown to be effective and safe in patients undergoing continuous renal replacement therapy for acute renal failure.
Kawada T 等人：“使用电刺激对颈动脉窦压力反射传递特征进行闭环识别。”Jpn J Physiol。
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