萘莫司他抗凝在连续性肾脏替代治疗中应用及管理的最佳证据总结

doi:10.3761/j.issn.2096-7446.2026.08.020

摘要/Abstract

摘要：

目的检索、评价并总结萘莫司他抗凝在连续性肾脏替代治疗（continuous renal replacement therapy，CRRT）中应用及管理的最佳证据，为临床实践提供循证依据。方法系统检索国内外循证资源及数据库，包括BMJ Best Practice、UpToDate、Cochrane Library、乔安娜布里格斯研究所（Joanna Briggs Institute，JBI）循证卫生保健中心数据库、PubMed、Embase、中国知网、万方数据、维普网等，检索关于萘莫司他在CRRT抗凝中应用的指南、证据总结、系统评价、专家共识及随机对照试验。检索时限为建库至2025年7月30日。由2名研究者独立进行文献质量评价和证据提取。结果共纳入21篇文献，包括指南4篇、专家共识3篇、系统评价5篇、随机对照试验5篇、观察性研究4篇。最终从抗凝指征、禁忌证、用药方案、监测要点、并发症管理、护理实践6个方面汇总了27条最佳证据。结论萘莫司他作为一种广谱丝氨酸蛋白酶抑制剂，对于高出血风险患者的CRRT抗凝具有独特优势。建议医护人员结合患者具体情况，遵循证据，实施规范化的给药、精细化的监测和多学科协作的管理模式，以最大程度发挥其治疗优势，减少并发症，确保CRRT治疗的顺利实施，改善患者预后。

关键词: 萘莫司他, 连续性肾脏替代治疗, 抗凝, 循证实践, 证据总结

Abstract:

Objective To retrieve，evaluate，and summarize the best evidence on the application and management of nafamostat mesilate（NM） anticoagulation in continuous renal replacement therapy（CRRT），providing an evidence-based foundation for clinical practice. Methods Systematic searches were conducted in domestic and international evidence-based resources and databases，including BMJ Best Practice，UpToDate，Cochrane Library，JBI EBP Database，PubMed，Embase，CNKI，Wanfang Data，and VIP. The search included guidelines，evidence summaries，systematic reviews，expert consensuses，and randomized controlled trials（RCTs） on the use of NM for anticoagulation in CRRT. The search timeframe was from database inception to July 30，2025. Two researchers independently performed literature quality appraisal and evidence extraction. Results A total of 21 publications were included，comprising four guidelines，three expert consensuses，five systematic reviews，five randomized controlled trials，and four observational studies. Twenty-seven best evidence statements were ultimately summarized across six domains，including indications for anticoagulation，contraindications，medication regimens，key monitoring points，complication management，and nursing practice. Conclusion Nafamostat mesilate，as a broad-spectrum serine protease inhibitor，offers distinct advantages for CRRT anticoagulation in patients at high risk of bleeding. Healthcare professionals are advised to develop a standardized administration protocol，implement meticulous monitoring，and adopt a multidisciplinary collaborative management model，tailored to the patient’s specific condition. This approach aims to maximize the therapeutic benefits of nafamostat，minimize complications，ensure the smooth implementation of CRRT，and improve patient outcomes.

Key words: Nafamostat Mesilate, Continuous Renal Replacement Therapy, Anticoagulation, Evidence-Based Practice, Evidence Summary

金玉峰, 薛玉龙, 申存毅, 邢斌瑜, 何栋. 萘莫司他抗凝在连续性肾脏替代治疗中应用及管理的最佳证据总结[J]. 中华急危重症护理杂志, 2026, 7(8): 1009-1016.

JIN Yufeng, XUE Yulong, SHEN Cunyi, XING Binyu, HE Dong. Application and management of nafamostat mesilate anticoagulation in continuous renal replacement therapy：a best evidence summary[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(8): 1009-1016.

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