在连续脏替代疗法期间去除肝素.
James F Colbert1,2, Benjamin R Griffin3, Kristy Rolloff4
1Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA, james.colbert@cuanschutz.edu.
Blood purification
|November 5, 2023
概括
持续置换疗法 (CRRT) 在两天内显著降低了急性损伤 (AKI) 或末期病 (ESKD) 的患者的肝素水平. 这一发现表明CRRT可能会影响铁平衡和病原体防御,这需要进一步的临床研究.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 关键护理医学 关键护理医学
- 免疫学 免疫学 免疫学
背景情况:
- 持续置换疗法 (CRRT) 对于治疗急性损伤 (AKI) 和末期病 (ESKD) 是必不可少的.
- CRRT的广泛溶解物去除可能会无意中耗尽有益的物质,如肝素,一种对铁稳定和病原体防御至关重要的抗微生物.
研究的目的:
- 调查CRRT启动对AKI或ESKD患者血清肝素水平的影响.
- 为了确定CRRT是否在治疗期间显著改变肝素度.
主要方法:
- 一项前性观察性研究,涉及13名需要CRRT的患者 (11名AKI,2名ESKD).
- 在CRRT启动后3天内采集了血和废水样本.
- 测量了肝素度,并与健康对照组进行比较;计算了肝素选系数.
主要成果:
- 与健康对照组相比,启动CRRT的患者的基线肝素水平显著更高 (158 ± 60相比17 ± 3 ng/mL).
- 肝素水平在CRRT的第1天 (102 ± 24 ng/mL) 和第2天 (56 ± 14 ng/mL) 显著下降,在第3天 (51 ± 11 ng/mL) 稳定下来.
- 肝素选系数的中位数始终很高 (0.82-0.83),表明通过CRRT有效去除.
结论:
- 开始CRRT后,在治疗的前两天内,血肝素水平迅速显著降低.
- 这种减少发生不论CRRT的原因或底层ESKD的存在.
- 鉴于低肝素与死亡率增加的相关性,需要进一步的临床研究来探索CRRT诱导的肝素去除对患者结局的影响.
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