在ECMO上对肝素耐药的婴儿使用比瓦利鲁丁抗凝剂:一个案例报告
Siqi Guo1,2, Lan Chen1,2, Jing Shi1,3
1Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, China.
Medicine
|October 28, 2024
概括
在新生儿外体膜氧化 (ECMO) 中管理抗凝血是具有挑战性的. 这一案例强调了使用比瓦利鲁丁和先进的监测,包括血栓-抗血栓复合物 (TAT),以确保在重症婴儿中安全有效的抗凝药.
科学领域:
- 新生儿重症监护室新生儿重症监护室
- 儿科重症监护医药 儿科重症监护医药
- 身体之外的生命支持.
背景情况:
- 身体外膜氧化 (ECMO) 是重症儿童的重要生命支持系统,新生儿有最好的预后 (74%的存活率).
- 在ECMO期间管理凝血平衡是关键的,因为高风险的出血和血栓形成.
- 新生儿生理学与成年人相比,呈现出独特的静血挑战.
研究的目的:
- 在接受ECMO的新生儿中描述抗凝的管理.
- 为了应对肝素监测的挑战,并探索替代抗凝策略.
- 为了评估比瓦利鲁丁和新生儿ECMO中高级实验室监测的有效性.
主要方法:
- 一个患有呼吸困扰的满期男性婴儿接受了静脉动脉ECMO与初始氨酸抗凝剂.
- 遇到氨酸耐药性,导致切换到比瓦利鲁丁.
- 使用激活凝血时间 (ACT),激活部分血栓塑时间,血栓素-抗血栓素复合物 (TAT) 和血栓凝结学 (TEG) - ACT来管理抗凝血治疗.
主要成果:
- 婴儿的呼吸和循环功能在ECMO上与bivalirudin稳定.
- 在治疗期间没有观察到出血并发症.
- 在达到稳定的生理参数后,ECMO成功奶.
结论:
- 比瓦利鲁丁可以在新生儿ECMO中作为有效的抗凝剂,但精确的剂量调整需要仔细监测.
- 最佳的实验室监测至关重要,而临床ACT可能并不总是足够的.
- 将激活的部分血栓形成时间与TAT结合起来,并考虑TEG-ACT可以帮助复杂的抗凝管理.
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