Objective  To explore the efficacy of nafamostat mesilate (NM) in patients requiring continuous renal replacement therapy (CRRT) treatment after cardiopulmonary resuscitation, as well as its impact on oxidative stress and organ function.

Methods  A retrospective analysis was performed on patients who underwent CRRT after cardiopulmonary resuscitation at Lishui People's Hospital from January 2023 to January 2025. The patients were divided into an observation group (NM anticoagulation) and a control group (low molecular weight heparin anticoagulation) based on the anticoagulation method. Oxidative stress, biochemical parameters, coagulation function, cerebral oxygen metabolism, blood gas parameters, scale scores, and clinical efficacy were compared between the two groups before and after the treatment.

Results  A total of 124 patients were included, including 65 in the observation group and 59 in the control group. After treatment, compared with the control group, the potassium, sodium, urea nitrogen, creatinine, malondialdehyde, coagulation index, coagulation angle, maximum amplitude, jugular venous oxygen saturation, arterial carbon dioxide partial pressure, plasma actual bicarbonate, Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Score II, and mortality in the observation group were reduced (P<0.05); while glutathione peroxidase, superoxide dismutase, cerebral oxygen metabolic rate, cerebral blood flow, oxygen content difference, coagulation formation time, coagulation reaction time, arterial oxygen partial pressure, blood oxygen saturation, Glasgow Coma Scale, renal function recovery rate, and total clinical efficacy were increased in the observation group (P<0.05).

Conclusion  In patients requiring CRRT after cardiopulmonary resuscitation, NM anticoagulation can improve oxidative stress indicators, protect organ function from damage, and regulate coagulation function and blood gas changes.

1.Maeda M, Hirata N, Chaki T, et al. Risk factors of cardiac arrest and failure to achieve return of spontaneous circulation during anesthesia: a 20-year retrospective observational study from a tertiary care university hospital[J]. J Anesth. 2022, 36(2): 221-229. DOI: 10.1007/s00540-021-03034-3.

2.唐春福, 张军根, 王建岗, 等. 以胸外按压比例为核心指标的心脏骤停院前救治培训设计与效果观察[J]. 中华急诊医学杂志, 2022, 31(4): 504-507. [Tang CF, Zhang JG, Wang JG, et al. Observation on the design and effect of prehospital cardiac arrest treatment training with chest compression ratio as the core index[J]. Chinese Journal of Emergency Medicine, 2022, 31(4): 504-507.] DOI: 10.3760/cma.j.issn.1671-0282.2022.04.013.

3.Greif R, Bray JE, Djärv T, et al. 2024 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces[J]. Circulation, 2024, 150(24): 580-687. DOI: 10.1161/CIR.0000000000001288.

4.韦妍飞, 李琪, 孙婧. 枸橼酸钠抗凝用于脓毒症伴急性肾损伤连续性肾脏替代治疗的效果及对凝血功能的影响[J]. 中国药业, 2022, 31(7): 102-105. [Wei YF, Li Q, Sun J. Effect of sodium citrate anticoagulation in continuous renal replacement therapy for sepsis with acute renal injury and its effect on coagulation function[J]. China Pharmaceuticals, 2022, 31(7): 102-105.] DOI: 10.3969/j.issn.1006-4931.2022.07.026.

5.文苑, 祝娟娟. 双重血浆分子吸附系统序贯血浆置换联合连续性肾脏替代疗法治疗慢加急性肝衰竭合并急性肾损伤的效果分析[J]. 临床肝胆病杂志, 2024, 40(3): 556-561. [Wen  Y, Zhu JJ. Analysis of the effect of sequential plasma exchange with dual plasma molecular adsorption system combined with continuous renal replacement therapy in the treatment of acute-on-chronic liver failure complicated with acute kidney injury[J]. Journal of Clinical Hepatobiliary Diseases, 2024, 40(3): 556-561.] DOI: 10.12449/JCH240319.

6.Xie Y, Cheng Z, Deng C, et al. Nafamostat mesilate for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis based on prospective, randomized, and controlled trials[J]. Medicine (Baltimore), 2023, 102(41): 35174. DOI: 10.1097/MD.0000000000035174.

7.朱倩莹, 程立新, 黄兰, 等. 甲磺酸萘莫司他体外抗凝在脓毒症合并急性肾损伤患者连续性肾脏替代治疗中的应用评价[J]. 华西医学, 2023, 38(5): 718-723. [Zhu QY, Cheng  LX, Huang  L, et al. Evaluation of in vitro anticoagulation with nafamostat mesilate in continuous renal replacement therapy in patients with sepsis complicated with acute kidney injury[J]. West China Medical Journal, 2023, 38(5): 718-723.] DOI: 10.7507/1002-0179.202206024.

8.中华医学会急诊医学分会复苏学组, 中国医药教育协会急诊专业委员会. 成人体外心肺复苏专家共识更新（2023版）[J]. 中华急诊医学杂志, 2023, 32(3): 298-304. [Resuscitation Group of the Emergency Medicine Branch of the Chinese Medical Association, Emergency Medicine Specialty Committee of the Chinese Medical Education Association. Update of the expert consensus on adult extracorporeal cardiopulmonary resuscitation (version 2023)[J]. Chinese Journal of Emergency Medicine, 2023, 32(3): 298-304.] DOI: 10.3760/cma.j.issn.1671-0282.2023.03.005.

9.中华医学会肾脏病学分会专家组. 连续性肾脏替代治疗的抗凝管理指南[J]. 中华肾脏病杂志, 2022, 38(11): 1016-1024. [Chinese Medical Association Nephrology Section Expert Group. Guidelines for anticoagulation management in continuous renal replacement therapy[J]. Chinese Journal of Nephrology, 2022, 38(11): 1016-1024.] DOI: 10.3760/cma.j.cn441217-20220620-00149.

10.Kc B, Adil MZ. Knowledge of glasgow coma scale among nurses in a tertiary care centre: a descriptive cross-sectional study[J]. JNMA J Nepal Med Assoc, 2022, 60(252): 723-726. DOI: 10.31729/jnma.7673.

11.Laczynski DJ, Gallop J, Sicard GA, et al. Benchmarking a center of excellence in vascular surgery: using acute physiology and chronic health evaluation II to validate outcomes in a tertiary care institute[J]. Vasc Endovascular Surg, 2023, 57(8): 856-862.DOI: 10.1177/15385744231183744.

12.Fleiss N, Polin RA. Sequential organ failure assessment scores to predict outcomes: from adults to neonates[J]. Curr Opin Pediatr, 2023, 35(2): 218-222. DOI: 10.1097/MOP.0000000000001207.

13.穆妮热·阿卜力孜, 张菁菁, 穆妮热·艾尔肯, 等. 低分子肝素钠与枸橼酸钠对重症急性肾损伤行连续性肾脏替代治疗患者抗凝及治疗效果的对比[J]. 临床肾脏病杂志, 2021, 21(6): 472-479. [Munire ABLZ, Zhang JJ, Munire AEK, et al. Comparison of anticoagulation and therapeutic effects of low-molecular-weight heparin sodium and sodium citrate on patients with severe acute kidney injury undergoing continuous renal replacement therapy[J]. Journal of Clinical Nephrology, 2021, 21(6): 472-479.] DOI: 10.3969/j.issn.1671-2390.20210109.

14.Sun S, Mei X. Effect of CASC15 on apoptosis and oxidative stress of cardiomyocytes after hypoxia/reperfusion injury[J]. Rev Port Cardiol, 2024, 43(2): 77-84. DOI: 10.1016/j.repc.2023.04.017.

15.郭志强, 刘云峰, 王佳, 等. 安宫牛黄丸联合亚低温对心脏骤停心肺复苏后患者脑氧代谢率及氧化应激损伤的影响 [J]. 湖北中医药大学学报, 2022, 24(5): 20-23. [Guo ZQ, Liu  YF, Wang  J, et al. Effects of Angong Niuhuang pills combined with mild hypothermia on cerebral oxygen metabolism rate and oxidative stress injury in patients with cardiac arrest after cardiopulmonary resuscitation[J]. Journal of Hubei University of Chinese Medicine, 2022, 24(5): 20-23.] DOI: 10.3969/j.issn.1008-987x.2022.05.04.

16.Nakayama T, Ito K, Inagaki F, et al. Pheochromocytoma crisis rescued by veno-arterial extracorporeal membrane oxygenation and continuous renal replacement therapy[J]. Am Surg, 2023, 89(6): 2857-2860. DOI: 10.1177/00031348211063573.

17.薛乾隆, 贺英, 王慧, 等. 心跳呼吸骤停患者心肺复苏术后早期实施连续性肾脏替代疗法临床观察[J]. 山东医药, 2020, 60(24): 72-74. [Xue QL, He Y, Wang H, et al. Clinical observation on early implementation of continuous renal replacement therapy after cardiopulmonary resuscitation in patients with cardiac respiratory arrest[J]. Shandong Medical Journal, 2020, 60(24): 72-74.] DOI: 10.3969/j.issn.1002-266X.2020.24.019.

18.施晨, 熊万鹏, 谭莹莹, 等. 新型抗凝剂甲磺酸萘莫司他在急诊连续性肾脏替代治疗中的临床应用研究[J]. 临床和实验医学杂志, 2024, 23(9): 934-937. [Shi C, Xiong  WP, Tan YY, et al. Clinical application research of the new anticoagulant natholimus mesylate in emergency continuous renal replacement therapy[J]. Journal of Clinical and Experimental Medicine, 2024, 23(9): 934-937.] DOI: 10.3969/j.issn.1671-4695.2024.09.010.

19.王晋祥, 续国武, 靳衡, 等. 亚低温治疗对猪心脏骤停体外心肺复苏后凝血功能及炎性因子的影响[J]. 天津医药, 2023, 51(9): 968-971. [Wang JX, Xu GW, Jin H, et al. Effects of mild hypothermia treatment on coagulation function and inflammatory factors in a swine model after cardiac arrest and extracorporeal cardiopulmonary resuscitation[J]. Tianjin Medical Journal, 2023, 51(9): 968-971.] DOI: 10.11958/20230001.

20.Nguyen SMT, Rupprecht CP, Haque A, et al. Mechanisms governing anaphylaxis: inflammatory cells, mediators, endothelial gap junctions and beyond[J]. Int J Mol Sci, 2021, 22(15): 7785. DOI: 10.3390/ijms22157785.

21.王艳, 吴学芬, 陈瑶, 等. 心痛舒散剂加减治疗稳定型心绞痛的疗效及其对患者血脂、肝功能、凝血功能的影响[J]. 实用心脑肺血管病杂志, 2024, 32(5): 83-87. [Wang Y, Wu  XF, Chen Y, et al. Efficacy of modified Xintongshu powder in the treatment of patients with stable angina pectoris and its influence on blood lipids,liver function,and coagulation function[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2024, 32(5): 83-87.] DOI: 10.12114/j.issn.1008-5971.2024.00.069.

22.李斌, 李昂, 张绍杰, 等. 甲磺酸萘莫司他在心脏外科术后应用体外膜肺氧合患者中抗凝的有效性与安全性研究[J]. 中华实验外科杂志, 2024, 41(8): 1712-1715. [Li B, Li A, Zhang SJ, et al. Efficacy and safety of namostat mesylate for anticoagulation in patients with extracorporeal membrane oxygenation after cardiac surgery[J]. Chinese Journal of Experimental Surgery, 2024, 41(8): 1712-1715.] DOI: 10.3760/cma.j.cn421213-20240513-01452.

23.李静, 杨琴, 张雪峰, 等. 中等剂量多巴胺联合肾上腺素对心跳骤停患者抢救成功率和自主循环恢复时间及脑氧代谢指标的影响[J]. 临床急诊杂志, 2022, 23(8): 572-575. [Li J, Yang Q, Zhang XF, et al. Effects of medium-dose dopamine combined with epinephrine on the rescue success rate and spontaneous circulation recovery time and cerebral oxygen metabolism indexes in patients with cardiac arrest[J]. Journal of Clinical Emergency, 2022, 23(8): 572-575.] DOI: 10.13201/j.issn.1009-5918.2022.08.006.

24.王红宇, 张思森, 毛峥嵘, 等. 注射用丹参多酚酸盐联合参附汤对心肺复苏患者的临床疗效评价[J]. 中医学报, 2022, 37(1): 201-204. [Wang HY, Zhang SS, Mao ZR, et al. Clinical evaluation of salvianolate for injection combined with Shenfu decoction on patients with cardiopulmonary resuscitation[J]. China Journal of Chinese Medicine, 2022, 37(1): 201-204.] DOI: 10.16368/j.issn.1674-8999.2022.01.037.

25.吕骏卿, 籍强, 郭婷婷. 氢溴酸山莨菪碱对心脏骤停行心肺复苏患者微循环及冠状动脉内皮功能的影响[J]. 中国急救复苏与灾害医学杂志, 2022, 17(7): 856-859. [Lyu JQ, Ji Q, Guo  TT. Effects of anisodamine hydrobromide on microcirculation and coronary endothelial function in patients undergoing cardiopulmonary resuscitation for cardiac arrest[J]. Chinese Journal of Emergency Resuscitation and Disaster Medicine, 2022, 17(7): 856-859.] DOI: 10.3969/j.issn.1673-6966.2022.07.004.

26.付国强, 任彬, 黄谭, 等. 连续性肾脏替代疗法联合低分子量肝素治疗创伤性凝血障碍合并急性呼吸窘迫综合征患者的疗效分析[J]. 中国医刊, 2022, 57(4): 433-437. [Fu GQ, Ren  B, Huang T, et al. Analysis of the efficacy of continuous renal replacement therapy combined with low molecular weight heparin in the treatment of patients with traumatic coagulation disorder complicated with acute respiratory distress syndrome[J]. Chinese Journal of Medicine, 2022, 57(4): 433-437.] DOI: 10.3969/j.issn.1008-1070.2022.04.023.

27.许威, 冷菊. 甲磺酸萘莫司他的临床应用及研究进展[J]. 首都食品与医药, 2023, 30(19): 16-18. [Xu W, Leng J. The clinical application and reseach progress of nafamostat mesilate[J]. Capital Food and Medicine, 2023, 30(19): 16-18.] DOI: 10.3969/j.issn. 1005-8257.2023.19.006.

28.Nayak AP, Lim JM, Arbel E, et al. Cooperativity between β-agonists and c-Abl inhibitors in regulating airway smooth muscle relaxation[J]. FASEB J, 2021, 35(7): 21674. DOI: 10.1096/fj.202100154R.