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持续置换治疗的抗凝血实践:对来自美国的医生的调查
David Boldt1, Laurence Busse2, Lakhmir S Chawla3
1Department of Anesthesiology and Perioperative Medicine, UCLA Healthcare System and David Geffen School of Medicine, Los Angeles, CA, USA.
Renal failure
|December 11, 2023
概括
连续脏替代疗法 (CRRT) 的使用量有所增加. 未分离的肝素是最常见的抗凝剂,但仍然存在担忧. 需要进一步评估CRRT抗凝剂选择.
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
- 药理学 药理学是指药理学的学科.
背景情况:
- 抗凝剂对于患有低出血风险的患者的连续置换疗法 (CRRT) 至关重要.
- 系统性肝素和区域性酸盐是美国目前的CRRT抗凝剂选择.
- 了解CRRT当前的抗凝剂实践是必不可少的,因为治疗使用量增加.
研究的目的:
- 调查科医生和重症监护医学 (CCM) 专家关于他们在CRRT中使用抗凝剂.
- 确定美国CRRT抗凝药的趋势和挑战.
主要方法:
- 对150名经过董事会认证的医生 (70名科医生,80名CCM专家) 进行了30个问题的调查.
- 受访者在学术医疗中心或社区医院工作.
- 该调查评估了抗凝剂的选择,不使用的原因以及相关并发症.
主要成果:
- 从疫情前到2022年,CRRT机器的使用量增加了30%左右.
- 大多数人使用的是未分离的肝素 (43%),其次是酸盐 (28%);29%的人没有服用抗凝剂.
- 避免酸盐的原因包括低血症风险 (52%) 和安全问题 (42%).
- 过器堵塞 (84%) 和输血增加 (25%) 发生在没有抗凝药的情况下.
- 肝素因成本和可用性而受到青,但引发了安全问题 (HIT,出血).
- 酸盐使用与低血症 (37%) 和酸盐锁定 (17%).
结论:
- 该研究强调了美国CRRT利用率的增加和抗凝固剂实践的变化.
- 现有的CRRT抗凝剂选择带来了挑战,包括安全性和有效性.
- 需要进一步评估当前和新型的CRRT抗凝剂策略.
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