Nongnuch Arkom, Tangsujaritvijit Viratch, Davenport Andrew
Renal Unit, Department of Medicine Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, Thailand -
Minerva Urol Nefrol. 2016 Feb;68(1):87-104. Epub 2015 Oct 16.
Patients with acute kidney injury are generally prothrombotic, and as such prone to increased risk of clotting in extracorporeal renal replacement therapy (RRT) circuits. Although some patients may be adequately treated by intermittent RRT, however due to cardiovascular instability many patients are treated by continuous renal replacement therapy (CCRT) or prolonged intermittent renal replacement therapy (PIRRT). Clotting in the RRT circuit not only reduces the efficiency of solute clearances, affects fluid balance, but also has economic health care costs. The longer duration RRT modes, CRRT and PIRRT are more prone to clotting, and more dependent on adequate anticoagulation. This review will compare the currently available systemic and regional anticoagulation options for CRRT and PIRRT for the patient with acute kidney injury.
急性肾损伤患者通常具有血栓形成倾向，因此在体外肾脏替代治疗（RRT）回路中发生凝血的风险增加。虽然一些患者可通过间歇性RRT得到充分治疗，但由于心血管不稳定，许多患者需接受持续肾脏替代治疗（CCRT）或延长间歇性肾脏替代治疗（PIRRT）。RRT回路中的凝血不仅会降低溶质清除效率、影响液体平衡，还会产生经济医疗成本。持续时间较长的RRT模式，即CRRT和PIRRT，更容易发生凝血，且更依赖于充分的抗凝治疗。本综述将比较目前可用于急性肾损伤患者的CRRT和PIRRT的全身性和局部抗凝方案。
