新生儿和儿童ECMO中的抗凝管理

A. Elias, C. Casado, Ana Mayordomo, R. García, Diego Solis, Blanca Ramirez
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引用次数: 0

摘要

引言:尽管近年来用于体外生命支持的材料、组件和技术取得了重大进展,但ECMO中的抗凝管理仍然存在争议,本协议的目的是开发婴儿ECMO抗凝及其控制的更新。发展:未分离肝素是ECMO抗凝治疗的首选药物。儿科使用的肝素剂量大多是根据成人的经验改编的,没有相应的验证,也限制了儿童随机临床试验的缺乏。在建立ECMO之前,对患者进行评估并可能纠正凝血功能障碍,并决定在插管前给予50-100 IU/kg体重的肝素丸。在ECMO开始的5-10 '进行ACT控制,如果该值大于300sg,则在30-60 '重复ACT。一旦ACT低于300,在没有大出血的情况下,开始在10-20 IU/kg/h之间输注。每隔30分钟进行一次控制,以将ACT稳定在选定的范围内。对于对照组,主要使用ACT和APTT,儿童年龄越高结果越好,尽管抗xa试验是唯一的实验室试验,显示与ECMO中给予的肝素剂量有很强的相关性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Anticoagulation management in neonatal and pediatric ECMO
Introduction: Despite significant advances in the materials, components and techniques used for extracorporeal life support in recent years, the management of anticoagulation in ECMO remains controversial, the objective of this protocol is to develop an update for anticoagulation and its control for infants ECMO. Development: Unfractionated heparin is the drug of choice for anticoagulation in ECMO. The heparin dose used in pediatrics have been mostly adapted from the experience in adults without a corresponding validation, as well as limiting the absence of randomized clinical trials in children. After the assessment of the patient and a possible correction of coagulopathies, prior to establishment of ECMO, as well as decide the administration of a heparin bolus of 50-100 IU/kg of body weight at the time prior to cannulation. At 5-10’ of beginning ECMO a ACT control is made, if the value is greater than 300 sg, ACT is repeated at 30-60’. Once the ACT is less than 300, an infusion starts between 10-20 IU/kg/h, in the absence of major bleeding. Controls will be carried out every 30’ to stabilize the ACT in the chosen range. For the control, the ACT will be used, mainly, and the APTT, with better results the higher the child's age, although the anti-Xa test is the only laboratory test that shows a strong correlation with the heparin dose administered in ECMO.
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