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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.

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Çocuk Yoğun Bakım Ünitelerinde Sürekli Renal Replasman Tedavisinde Sitrat ve Heparinin Karşılaştırılması

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References