外周静脉置管行慢性双重滤过血浆置换联合局部枸橼酸抗凝的可行性、疗效和安全性。

Feasibility, Efficacy, and Safety of Peripheral Venous Access for Chronic Double-Filtration Plasmapheresis with Regional Citrate Anticoagulation.

机构信息

Service Néphrologie-Dialyse-Aphérèse, CHU Nîmes, Nîmes, France.

IDESP UMR, Montpellier, France.

出版信息

Blood Purif. 2023;52(7-8):621-630. doi: 10.1159/000531688. Epub 2023 Aug 3.

DOI:10.1159/000531688

PMID:37536292

Abstract

INTRODUCTION

Peripheral venous access (PVA) is recommended as a first-line vascular approach for therapeutic plasmapheresis with centrifugation methods but not filtration, which usually requires high blood flow. We evaluated the feasibility, efficacy, and safety of double-filtration plasmapheresis (DFPP) with PVA, using ultrasound guidance and regional citrate anticoagulation (RCA), i.e., PVA-RCA-DFPP in patients undergoing chronic DFPP. Secondly, we assessed the number of central venous catheters (CVCs) avoided.

METHODS

A single-center retrospective study evaluated 22 adult patients on chronic DFPP to perform PVA-RCA-DFPP. They were classified into 3 groups: successful (i.e., completion of sessions with PVA), primary failure (i.e., no sessions completed), secondary failure (i.e., ≥1 session with PVA completed but secondary return with CVC or arteriovenous fistula).

RESULTS

Among the 22 patients included (64% men), 7 patients (32%) were classified as primary failures (2 patient refusals, 5 inadequate PVAs), 1 patient (5%) as a secondary failure (due to uncomfortable venipunctures), and 14 patients (64%) as successful. In the successful group including 12 patients treated for chronic inflammatory demyelinating polyneuropathy (CIDP) and 2 patients for familial hypercholesterolemia (FH) (2 patients), 116 sessions were performed, with a median treated plasma volume of 4.3 L [IQR 3.6-4.6] (45 mL/kg) for a median duration of 134 min [IQR 122-144], and a median blood flow of 94 mL/min [IQR 87-103]. For the CIDP group, 90% of sessions achieved a plasma volume >1 TPV, and for the FH group 91% of sessions achieved an LDLc reduction >60%. Eleven sessions out of 116 (9%) were interrupted, mostly due to PVA dysfunction (5/11) and circuit clotting (4/11). Session interruptions decreased significantly between each patient's first and following sessions (29% to 7%, p = 0.009).

CONCLUSION

Chronic PVA-RCA-DFPP can be performed safely and efficiently, avoiding the use of CVCs.

摘要

简介

外周静脉通路（PVA）被推荐为离心法治疗性血浆置换的首选血管入路，但不包括过滤法，后者通常需要较高的血流量。我们评估了超声引导下应用局部枸橼酸盐抗凝（RCA）的 PVA-RCA-DFPP 在接受慢性双重滤过血浆置换（DFPP）的患者中的可行性、疗效和安全性。其次，我们评估了避免使用中心静脉导管（CVC）的数量。

方法

一项单中心回顾性研究评估了 22 例接受慢性 DFPP 的成年患者，进行 PVA-RCA-DFPP。他们被分为 3 组：成功组（即完成 PVA 治疗的所有疗程）、原发性失败组（即未完成任何疗程）、继发性失败组（即至少完成 1 个 PVA 疗程，但随后因 CVC 或动静脉瘘而返回）。

结果

在纳入的 22 例患者中（64%为男性），7 例（32%）被归类为原发性失败（2 例患者拒绝，5 例 PVA 不充分），1 例（5%）为继发性失败（由于静脉穿刺不适），14 例（64%）为成功。在成功组中，包括 12 例慢性炎症性脱髓鞘性多发性神经病（CIDP）患者和 2 例家族性高胆固醇血症（FH）患者（2 例），共进行了 116 次治疗，中位血浆处理量为 4.3 L [IQR 3.6-4.6]（45 mL/kg），中位治疗时间为 134 min [IQR 122-144]，中位血流速度为 94 mL/min [IQR 87-103]。对于 CIDP 组，90%的疗程达到了 >1 TPV 的血浆量，而 FH 组 91%的疗程达到了 >60%的 LDLc 降低量。在 116 次治疗中有 11 次（9%）被中断，主要是由于 PVA 功能障碍（5/11）和回路凝血（4/11）。从每位患者的第一次治疗到随后的治疗，疗程中断的情况显著减少（从 29%降至 7%，p = 0.009）。