Anticoagulación en circuitos de terapias continuas de reemplazo renal

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2022-10-01 DOI:10.1016/j.enfi.2022.01.002

A. Mateos-Dávila RN, MsN, PhDc , J. Martínez Pérez RN, MsN , M.E. Prieto Arriba RN, MsN , R. Macho López RN , E.M. Guix-Comellas RN, MsN, PhD

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引用次数: 1

Abstract

Continuous renal replacement therapies are used as a means of blood clearance in critically ill patients with acute renal failure. Its effectiveness depends on the permeability of the extracorporeal circuit and filter coagulation is the most frequent cause of treatment interruption. This situation carries a risk of blood loss for the patient.

Sodium heparin is the most widely used anticoagulant in these therapies, but it can increase the risk of bleeding. Regional citrate anticoagulation is a safer method compared to sodium heparin.

Citrate is a substance that works by inactivating ionic calcium that participates in the coagulation cascade. It's infused at the inlet of the circuit and neutralized before reaching the patient with calcium replacement. For this reason, it is considered a regional and non-systemic anticoagulant.

However, this anticoagulation system, despite being indicated as the first option by the KDIGO guidelines (Kidney Disease Improving Outcomes), is not yet widespread due to the complexity of its use. It requires specific training for healthcare personnel, especially nurses, who will be responsible for maintaining the circuit while the therapy lasts.

In this article we want to provide the necessary knowledge about anticoagulation to carry out these procedures safely and effectively.

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连续肾替代疗法中的抗凝回路

持续肾替代疗法被用作急性肾功能衰竭危重患者血液清除的一种手段。其有效性取决于体外循环的通透性，滤过性凝血是导致治疗中断的最常见原因。这种情况有患者失血的风险。肝素钠是这些治疗中最广泛使用的抗凝血剂，但它会增加出血的风险。与肝素钠相比，局部柠檬酸抗凝是一种更安全的方法。柠檬酸盐是一种通过使参与凝血级联的离子钙失活而起作用的物质。它在静脉入口被注入在病人体内被钙替代之前被中和。因此，它被认为是一种局部和非全身抗凝血剂。然而，这种抗凝系统，尽管被KDIGO指南(肾脏疾病改善结局)列为首选，但由于其使用的复杂性，尚未得到广泛应用。这需要对医疗人员，特别是护士进行专门的培训，他们将在治疗期间负责维持电路。在本文中，我们希望提供必要的抗凝知识，以安全有效地进行这些手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.