在体外膜氧化疗法 (ECMO) 期间抗凝血监测策略 - 同时获得的凝血试验之间的差异:回顾性单中心队列研究
Alexander C Reisinger1, Nikolaus Schneider1, Marco Koellinger1
1Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Graz, Austria.
Journal of intensive care medicine
|February 6, 2025
概括
在体外膜氧化 (ECMO) 过程中监测未分离的氨酸 (UFH) 抗凝剂具有挑战性. R时间,激活的局部血栓形成时间 (aPTT) 和抗Xa活性显示出相关性差且不一致性高,影响患者的治疗结果.
科学领域:
- 关键护理医学 关键护理医学
- 血液学 血液学 血液学
- 心血管外科心血管外科
背景情况:
- 身体外膜氧化 (ECMO) 需要全身抗凝剂,通常是未分离的肝素 (UFH).
- 在ECMO期间对UFH抗凝的最佳监测仍然不确定,这可能会导致出血和血栓形成的风险.
研究的目的:
- 评估ECMO患者的R-时间 (血小板显微镜),激活的部分血小板质量时间 (aPTT) 和抗Xa活性之间的相关性和一致性.
- 评估凝血参数与死亡率,出血和血栓性并发症的关联.
主要方法:
- 在格拉茨医科大学对85例静脉和静脉动脉ECMO病例进行了回顾性分析.
- 对671个同时凝血试验结果 (R-时间,aPTT,抗Xa活性) 的分析.
- 调查目标范围内的测试比例及其与临床结果的相关性.
主要成果:
- 在R-时间,aPTT和抗Xa活性之间观察到高不一致性 (46%) 和差相关性.
- 只有21% (R-时间),15% (aPTT) 和44% (抗Xa活性) 的测量结果实现了治疗范围.
- 在VA-ECMO中抗Xa活性升高与出血事件增加有关;较低的aPTT与死亡率降低有关.
结论:
- 目前的凝血监测测试 (aPTT,anti-Xa,R-time) 在ECMO患者中显示出显著的异常.
- 经常发生出血事件,抗Xa活性升高是VA-ECMO的危险因素.
- 需要进一步的研究,以建立可靠的ECMO抗凝血监测策略.
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