在接受ECMO支持的患者中激活凝血时间和静血并发症:系统性审查
Daniel Schwaiger1, Lukas Schausberger1, Benedikt Treml1
1Department of Anaesthesiology and Intensive Care, Medical University of Innsbruck, Anichstraße. 35, 6020 Innsbruck, Austria.
Journal of cardiovascular development and disease
|July 25, 2025
概括
在用未分离的肝素 (UFH) 进行体外膜氧化 (ECMO) 期间,激活凝血时间 (ACT) 监测没有显示出与出血或血栓形成有显著联系. 目前的证据表明,ACT对ECMO抗凝管理可能不可靠.
科学领域:
- 关键护理医学 关键护理医学
- 心血管外科心血管外科
- 血液学 血液学 血液学
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),以防止电路血栓形成.
- 使用UFH的抗凝固药物具有固有的出血风险,需要谨慎监测.
- 激活凝血时间 (ACT) 经常用于监测UFH抗凝,但其在ECMO患者中的有效性仍在争论中.
研究的目的:
- 在接受ECMO的患者中,系统地审查现有证据,以了解ACT监测与血液静止并发症 (出血和血栓形成) 之间的关联.
- 在ECMO的背景下,评估ACT作为UFH抗凝药的监测工具的可靠性.
主要方法:
- 使用Scopus和PubMed数据库进行了系统的文献审查.
- 研究包括接受ECMO支持的患者,使用UFH抗凝剂,并通过ACT监测.
- 关于出血事件,血栓形成和死亡率的数据被提取和分析.
主要成果:
- 在3536个已识别的出版物中,包括了30项涉及2379名患者的研究.
- 大多数研究 (13/23) 发现ACT值和出血之间没有显著的关联.
- 综合数据显示,大出血率为49%,血栓形成率为25%,住院死亡率为51%.
结论:
- 对ECMO的最佳抗凝血监测策略尚不清楚.
- 目前的证据不支持在ECMO患者的ACT水平和血液静止并发症之间存在显著的关系.
- ACT可能是监测ECMO中UFH抗凝的不可靠工具,需要对替代方法进行调查.
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