Pozzato Marco
Ospedale San Giovanni Bosco, ASL TO2 Nord, Torino, Italy.
G Ital Nefrol. 2012 Jan-Feb;29(1):20-6.
Anticoagulation of the extracorporeal circuit, necessary for the correct management of renal replacement treatment in acute renal failure, is essential. There is a high risk of bleeding secondary to the presence of complex platelet and coagulation abnormalities, the effect of uremia, recent surgery or a state of sepsis. This requires careful evaluation of the type of anticoagulation to be used to prevent blood clotting of the circuit, maintain filter efficiency, and minimize the risk of bleeding. In critically ill patients with no risk of bleeding, heparin is still the anticoagulant treatment of choice. With an increased bleeding risk or in particular situations such as HIT-II, dermatan sulfate can be safely used as an alternative to dilution driven. A valid additional resource in case of a high risk of bleeding is citrate, the use of which - thanks to its effectiveness and ease of use - is becoming more widespread. Citrate is able to provide regional anticoagulation without any interference with the patient. This makes it increasingly feasible to continue replacement therapy, allowing a sufficient number of hours to obtain the correct dialysis dose in critically ill patients with acute renal failure.
对于急性肾衰竭患者的肾脏替代治疗的正确管理而言，体外循环的抗凝是必不可少的。由于存在复杂的血小板和凝血异常、尿毒症的影响、近期手术或脓毒症状态，出血风险很高。这就需要仔细评估所使用的抗凝类型，以防止体外循环凝血、维持滤器效率并将出血风险降至最低。在没有出血风险的重症患者中，肝素仍然是抗凝治疗的首选。在出血风险增加或处于特定情况（如Ⅱ型肝素诱导的血小板减少症）时，硫酸皮肤素可以安全地用作稀释驱动的替代药物。在出血风险高的情况下，一个有效的额外资源是枸橼酸盐，由于其有效性和易用性，其使用越来越广泛。枸橼酸盐能够提供局部抗凝，而不会对患者产生任何干扰。这使得继续进行替代治疗越来越可行，从而在患有急性肾衰竭的重症患者中留出足够的时间来获得正确的透析剂量。
