2025 年第 2 期 第 20 卷

比伐卢定和肝素在成人心脏外科术后接受体外膜氧合支持患者抗凝治疗中的有效性和安全性比较

Comparison of the efficacy and safety of anticoagulation therapy with bivalirudin and heparin in adult patients receiving extracorporeal membrane oxygenation support after cardiac surgery

作者：王睿任禹澄李颖周旺涛通耀威袁鑫杨自凯胥天伟宋云林

英文作者：Wang Rui Ren Yucheng Li Ying Zhou Wangtao Tong Yaowei Yuan Xin Yang Zikai Xu Tianwei Song Yunlin

单位：新疆医科大学第一附属医院重症医学中心，乌鲁木齐830054

英文单位：Center of Critical Care Medicine the First Affiliated Hospital of Xinjiang Medical University Urumchi 830054 China

关键词：成人心脏外科手术；体外膜肺氧合；比伐卢定；肝素；抗凝

英文关键词：Adultcardiacsurgery;Extracorporealmembraneoxygenation;Bivalirudin;Heparin;Anticoagulation

• 摘要：

• 目的 探讨比伐卢定和肝素在成人心脏外科术后接受体外膜氧合（ECMO）支持患者抗凝治疗中的有效性和安全性。方法 回顾性分析2018年3月至2024年6月在新疆医科大学第一附属医院重症医学中心成人心脏外科术后接受ECMO支持的56例患者的临床资料，根据ECMO支持期间应用抗凝药物不同分为肝素组（25例）和比伐卢定组（31例）。收集2组患者的基线资料及结局指标，比较2组ECMO支持时间、血小板计数（PLT）、凝血指标、ECMO成功撤机率、院内死亡率等指标及随访90 d的生存情况。结果 2组在年龄、性别分布、体重指数、ECMO模式、ECMO前PLT、ECMO前活化部分凝血活酶时间（APTT）、ECMO前急性生理学与慢性健康状况评分系统Ⅱ评分等基线资料方面差异均无统计学意义（均P＞0.05）。在结局指标方面，2组ECMO支持时间、血红蛋白平均值、ECMO支持期间APTT、ECMO支持期间激活全血凝固时间、血浆输注量及血栓形成、小出血、严重出血并发症发生率方面差异均无统计学意义（均P＞0.05）。比伐卢定组PLT最低值、PLT、血红蛋白最低值以及ECMO成功撤机率均高于肝素组，红细胞输注量、血小板输注量以及院内死亡率均少于/低于肝素组，差异均有统计学意义（均P＜0.05）。交叉效应分析结果显示组别与治疗前后不存在交互作用，即2组的治疗效应对ACT的作用具有相同的趋势（F交叉=0.509，P=0.799）。比伐卢定组和肝素组分别有25例患者（80.6%）和13例患者（52.0%）在第90天存活，比伐卢定组的整体存活率高于肝素组（Log-rank χ2=6.174，P=0.013）。结论 在成人心脏外科术后接受ECMO支持的患者中，应用比伐卢定进行抗凝治疗和肝素具有同样的抗凝效果，并且比伐卢定能够减少血制品输注量以及降低院内死亡率，增加ECMO成功撤机率，提高抗凝治疗的安全性。

• Objective To investigate the efficacy and safety of anticoagulation therapy with bivalirudin and heparin in adult patients receiving extracorporeal membrane oxygenation (ECMO) support after cardiac surgery. Methods The clinical data of 56 patients receiving ECMO support after adult cardiac surgery at the Department of Critical Care Medicine Center, the First Affiliated Hospital of Xinjiang Medical University from March 2018 to June 2024 were retrospectively analyzed.According to the application of anticoagulant drugs during ECMO support, patients were divided into heparin group (25 cases) and bivalirudin group (31 cases). The baseline data and outcome indicators of the two groups were collected, and the ECMO support time, platelet count, coagulation indicators, the rate of successful ECMO withdrawal, in-hospital mortality and survival at 90 d of follow-up were compared between the two groups. Results There were no significant differences in age, gender, body mass index, ECMO mode, platelet count, activated partial thromboplastin time (APTT) before ECMO, and acute physiology and chronic health evaluation Ⅱ score before ECMO between the two groups(all P>0.05). In terms of outcome measures, there were no significant differences in the duration of ECMO support, mean hemoglobin value, APTT during ECMO support, coagulation time of activated whole blood during ECMO support, plasma transfusion volume, and the incidence of thrombosis, minor bleeding, and severe bleeding complications between the two groups(all P>0.05). The lowest platelet count, platelet count, the lowest hemoglobin, and the rate of successful ECMO withdrawal in the bivalirudin group were higher than those in the heparin group, and the amount of red blood cell transfusion, platelet transfusion and in-hospital mortality in the heparin group were less than/lower than those in the heparin group (all P<0.05). The results of cross-effect analysis showed that there was no interaction between group and before and after treatment, that is, the treatment effect of the two groups had the same trend on the effect of ACT(Fcross=0.509, P=0.799). A total of 25 patients (80.6%) in the bivalirudin group and 13 patients (52.0%) in the heparin group were alive at day 90, with a higher overall survival rate in the bivalirudin group than in the heparin group (Log-rank χ2=6.174, P=0.013). Conclusion In adult patients receiving ECMO support after cardiac surgery, bivalirudin has the same anticoagulant effect as heparin, and can reduce blood product transfusion volume and in-hospital mortality, increase the probability of successful ECMO withdrawal, and improve the safety of anticoagulation therapy.