Öz
Giriş:
Sürekli renal replasman tedavisinde (CRRT) antikoagülasyon seçimi devre ömrü ve kanama komplikasyonları için çok önemlidir. Çalışmamızın birincil sonucu devre ömrü idi. İkincil sonuçlar, metabolik komplikasyonları belirlemeyi amaçladık.
Yöntemler:
Bu geriye dönük çalışma, Kasım 2019-Mart 2021 tarihleri arasında çocuk yoğun bakım ünitemizde yapılmıştır.
Bulgular:
Çalışmaya 19’u bölgesel sitrat antikoagülasyon (RCA) ve 16’sı heparin antikoagülasyonlu (HA) olmak üzere 35 hasta dahil edildi. Hastanın çocuk ölüm riski III skoru her iki grupta da benzerdi (p=0,76); SOFA puanları da benzer değildi [(HA: 6,43±5,24, RCA: 10,21±3,96, p=0,024)]. Toplam CRRT süresi 4115,50 saat idi. HA grubunda 43 ve RCA grubunda 57 olmak üzere toplam 100 hemofiltre seti kullanıldı. HA grubuna göre; medyan devre ömrü ve toplam CRRT süresi RCA grubunda daha uzundu [(33,0; 3,0-168,0) (30,5; 9,0-520,0) (14,0; 0,75-285,0) (94,0; 11,0-394,0) (p=0,043\0,021)]. Hipokalsemi RCA grubunda daha fazla idi [RCA: 9/19, HA: 4/16 (p=0,021)]. CRRT ile eş zamanlı ECMO ihtiyacı olan 3 hastada HA, 4 hastada RCA tercih edildi. RCA gruplarında devre değişikliğinin en sık nedeni hasta kaynaklı iken heparin grubunda pıhtılaşmadır. Mortalite oranları her iki grupta da aynı değildi (p=0,012).
Sonuç:
Sitrat 18/0, uzun filtre ömrü ve kolayca yönetilebilen sistemik komplikasyonlar ile daha iyi güvenlik ve etkinliğe sahiptir. Ayrıca ECMO ile izlenen ve CRRT ihtiyacı olan hastalarda RCA ile antikoagülasyon tercih edilebilir.
Anahtar Kelimeler: Heparin, bölgesel sitrat antikoagülasyon, sitrat 18/0, sürekli renal replasman tedavisi, çocuk yoğun bakım ünitesi
Kaynakça
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