RESUMO
The aim of this study was to discuss the safety and efficacy of regional citrate anticoagulation (RCA) on continuous blood purification (CBP) during the treatment of multiple organ dysfunction syndrome (MODS). Thirty-five patients with MODS were divided into two groups: the local citrate anticoagulation (RCA) group, and the heparin-free blood purification (hfBP) group. The MODS severity was assessed according to Marshall's MODS score criteria. Blood coagulation indicators, blood pressure, filter lifespan, filter replacement frequency, anticoagulation indicators, and main metabolic and electrolyte indicators were analyzed and compared between RCA and hfBP groups. RCA resulted in lower blood pressure than hfBP. The filter efficacy in RCA treatment was longer than in the hfBP group. The blood clearance of creatine, blood urea nitrogen and uric acid was better in the RCA group. RCA also led to higher pH than hfBP. Neither treatment resulted in severe bleeding events. In addition, MODS score was positively correlated with prothrombin time and activated partial thromboplastin time but negatively correlated with platelet concentration. RCA is a safer and more effective method in CBP treatment; however, it could also lead to low blood pressure and blood alkalosis.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Hemofiltração/métodos , Citratos/farmacologia , Ácido Cítrico/farmacologia , Glucose/farmacologia , Insuficiência de Múltiplos Órgãos/terapia , Anticoagulantes/farmacologia , Valores de Referência , Índice de Gravidade de Doença , Coagulação Sanguínea/efeitos dos fármacos , Heparina/farmacologia , Reprodutibilidade dos Testes , Resultado do Tratamento , Anticoagulantes/uso terapêuticoRESUMO
La hemofiltracion continua arteriovenosa (HCAV) es una tecnica extracorporea para el tratamiento de la sobrecarga de liquidos y de los desequilibrios electroliticos, asi como para la remocion del nitrogeno ureico y de otras sustancias toxicas, en procesos tales como la sepsis intraabdominal o la pancreatitis; asimismo, ha sido demostrada su utilidad para crear espacio en la nutricion parenteral en enfermos con severas restricciones hidricas o en el tratamiento de la falla renal postoperatoria o postraumatica, y en cirugia cardiaca, como tambien en el tratamiento del sindrome de deficiencia respiratoria aguda (SDRA). Esta tecnica es especialmente aplicable en pacientes criticos con inestabilidad hemodinamica. Un filtro especial y unas lineas modificadas de hemodialisis, pueden ser colocadas rapida y facilmente al paciente. Los liquidos y electrolitos son extraidos del paciente por ultrafiltracion. La presion arterial del mismo paciente incide dentro del filtro para producir ultrafiltrado, y no se requiere de bombas adicionales. El circuito puede dejarse colocado por dias y semanas. Se revisan los aspectos practicos de su utilizacion