Vázquez-Rodríguez Juan Gustavo
Unidad de Cuidados Intensivos Adultos, Hospital de Ginecología y Obstetricia 3, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, México, D.F., México.
Cir Cir. 2010 Jan-Feb;78(1):99-102.
Hemodialysis is the gold standard for substitution of renal function in women with chronic or acute renal insufficiency during pregnancy or during the postpartum period. Perinatal complications are frequent. Recognition of appropriate techniques in medical treatment of patients will contribute to decrease its incidence and allow better perinatal results. We undertook this study to review the techniques and medical indications of hemodialysis in pregnant and postpartum patients. This condition requires care in a high-specialty medical center. We recommend incremental increases in intensity and frequency and duration of treatments, use of equipment to manage fluctuations in blood and dialysis fluids, new filters, microdose of heparin and limiting ultrafiltration to avoid hemodynamic, electrolytic, and metabolic alterations, obstetrical hemorrhage or premature delivery. The objective is to maintain a satisfactory clinical status and maternal blood, urea, nitrogen (BUN) levels =80 mg/dl and creatinine 5-7 mg/dl for opportune fetal development and birth. Routine pharmacological treatment should continually be individually adjusted as to number of medications and dosage. Recognition of hemodialysis techniques and indications will contribute to obtaining improved perinatal results.
血液透析是孕期或产后慢性或急性肾功能不全女性肾功能替代的金标准。围产期并发症很常见。认识到对患者进行医疗治疗的适当技术将有助于降低其发生率并获得更好的围产期结果。我们进行这项研究以回顾孕妇和产后患者血液透析的技术和医学指征。这种情况需要在高度专业的医疗中心进行护理。我们建议逐步增加治疗强度、频率和持续时间，使用设备管理血液和透析液的波动，采用新的滤器，使用微剂量肝素并限制超滤以避免血流动力学、电解质和代谢改变、产科出血或早产。目标是维持令人满意的临床状态以及母体血液、尿素氮（BUN）水平≤80mg/dl和肌酐5 - 7mg/dl，以利于适时的胎儿发育和分娩。常规药物治疗应根据药物数量和剂量不断进行个体化调整。认识血液透析技术和指征将有助于获得更好的围产期结果。
