Kev Koom Tes Ntawm Kev Siv Cov Ntawv Sau Khoom Noj thiab Kev pheej hmoo ntawm Kab Mob Raum Hniav: Kauslim Teb Kev Noj Qab Haus Huv thiab Kev Tshawb Fawb Kev Tshawb Fawb (KNHANES) 2008-2019
Jul 04, 2023
TSEEM CEEB
1. Lub hom phiaj
Hauv Serbia, tus kab mob coronavirus 2019 (COVID-19) kis thoob qhov txhia chaw pib thaum lub Peb Hlis 2020.
Txoj kev tshawb no tsom mus rau cov ntsiab lus ntawm kev kho mob hauv kev kho mob ntawm COVID-19- cuam tshuam rau lub raum raug mob los ntawm cov txheej txheem ntawm kev kho lub raum tsis tu ncua (CRRT) nrog rau kev tsom mus rau tus nqi ntawm cov tshuaj noj ntawm cov tshuaj heparin uas tsis muaj kev cuam tshuam.
2. Cov txheej txheem
Txoj kev tshawb no suav nrog 12 tus neeg mob kho nrog CRRT ntawm Lub Tsev Kho Mob rau Kab Mob Sib Kis ntawm Lub Chaw Kho Mob ntawm Vojvodina txij lub Peb Hlis 6 txog Lub Tsib Hlis 20, 2020. Antithrombotic prophylaxis, kev pheej hmoo ntawm venous thromboembolism (VTE), siv kev kho mob, biochemical tsis ua ntej thiab tom qab CRRT, anticoagulation, thiab lwm yam CRRT tsis tau txheeb xyuas.
3. Cov txiaj ntsig
Qhov nruab nrab hnub nyoog ntawm cov neeg mob yog 61.54 ± 10.37 xyoo thiab xya (58.3 feem pua) yog txiv neej. Txhua tus neeg mob tau txais tus qauv thromboprophylaxis. Cuaj (75 feem pua) cov neeg mob muaj Padua Prediction Score for Risk of VTE Ntau dua los yog sib npaug rau 4, tab sis tsis muaj ib qho kev tshwm sim thrombotic. Xya tus neeg mob hnyav uas muaj ntau lub cev tsis ua haujlwm tau tsim mob raum raug mob nyob ntawm CRRT. Qhov nruab nrab koob tshuaj CRRT yog 36.6 ml / kg / h, qhov nruab nrab koob tshuaj ntawm unfractionated heparin yog 3250 ± 1138.18 IU, thiab cov koob tshuaj tas li yog 1112.5 ± 334.48 IU / kg / h. Kev txiav tawm ntawm CRRT vim yog lub voj voog txhaws yog tsim nyog rau tus neeg mob nkaus xwb. Cov txiaj ntsig ntawm leukocytes, AST, ALT, GGT, aPTT, thiab PT tau nce siab dua tom qab CRRT piv rau urea, creatinine, potassium, chlorine, thiab magnesium, uas nws cov nqi qis dua.
4. Cov lus xaus
Hauv peb cov neeg mob COVID-19 uas muaj cov kab mob tsis zoo thiab D-dimer thiab kwv yees qhov kev pheej hmoo ntawm kev tsim cov hlab ntsha sib sib zog nqus, qhov kev siv ua ntej dilution txuas ntxiv venovenous hemodiafiltration nrog cov tshuaj tiv thaiv kab mob thiab ¹/₃ rau ¹/₂ siab dua unfractionated koob tshuaj heparin ntau dua li qhov pom zoo, lub neej lim tau ntev dua yam tsis muaj teeb meem.
5. Cov ntsiab lus
COVID-19; kev kho mob raum tsis tu ncua; mob raum mob; cov xwm txheej thrombotic.
Nyem qhov no mus yuav Cistanche ntxiv
Taw qhia
Mob raum raug mob (AKI) feem ntau tshwm sim nyob rau hauv cov neeg mob hnyav, tshwj xeeb tshaj yog nyob rau hauv cov neeg mob uas muaj mob hnyav thiab nws muaj feem xyuam rau kev mob hnyav thiab kev tuag [1].
Ib qho kev ntsuam xyuas meta uas suav nrog 20 phau ntawv xov xwm thiab 6945 tus neeg mob tau pom tias muaj 8.9 feem pua ntawm AKI nyob rau hauv cov neeg mob nrog COVID-19, txawm hais tias kev txheeb cais sib txawv ntawm cov kev tshawb fawb tau pom [2]. Raws li cov kev tshawb fawb yav dhau los, kev kho lub raum hloov (RRT) yuav tsum tau 25 feem pua ntawm cov neeg mob COVID-19 mob hnyav [3].
Ntau qhov kev tshawb fawb tau pom tias chav kawm ntawm COVID-19 tuaj yeem ua rau muaj ntau yam kab mob thrombotic tshwm sim los ntawm o, hypoxia, nthuav tawm intravascular coagulation nrog rau qee yam tshuaj kawm [4]. Cov tshuaj no tuaj yeem ua rau muaj kev cuam tshuam loj heev nrog kev kho mob antithrombotic lossis anticoagulants [5].
Feem ntau cov hemostatic abnormality nyob rau hauv COVID-19 yog thrombocytopenia me me thiab qib siab ntawm D-dimer, uas muaj feem xyuam rau qhov muaj peev xwm ntau dua ntawm qhov xav tau kev siv tshuab ua pa (MV), ICU nkag, lossis qhov tshwm sim tuag [6] . Nws ntseeg tau tias qhov mob hnyav ntawm tus kab mob txuas mus rau lub sijhawm ntev prothrombin (PT) thiab thoob ntiaj teb kev sib piv (INR), thrombin lub sij hawm (TT), thiab lub sijhawm luv luv thromboplastin lub sij hawm (aPTT) [4]. Qhov kev txiav txim siab zaum kawg yog hais txog kev sib raug zoo ntawm hemostatic hloov nrog lub siab ua haujlwm tsis zoo hauv COVID-19 cov neeg mob [7]. Ib qib siab ntawm D-dimer yuav ua rau muaj teeb meem thrombotic hauv COVID-19 cov neeg mob [8].
Cov kev tshawb fawb tsis ntev los no tau tshaj tawm tias muaj venous thromboembolism (VTE) uas yog pulmonary embolism pom nyob rau hauv 16.7-35 feem pua ntawm cov neeg mob uas muaj ntau zaus mus txog 49 feem pua hauv 14 hnub [9, 10].
Txawm hais tias kev kho RRT tuaj yeem cuam tshuam nrog kev los ntshav ntau dua, qhov muaj ntau ntawm VTE txhawb kev siv cov thromboprophylaxis thaum tsis muaj ntshav los yog mob thrombocytopenia hnyav [11].
Hauv cov xwm txheej ntawm AKI, kev kho lub raum tsis tu ncua (CRRT) yog qhov kev kho mob zoo dua vim nws qhov cuam tshuam tsawg dua ntawm hemodynamic stability thiab tswj ntim txaus. Txawm li cas los xij, cov ntshav raug xa mus rau cov khoom siv hluav taws xob ua rau cov ntshav txhaws thiab nws tuaj yeem ua rau cov ntshav thrombosis ntau dua, uas ua rau muaj kev cuam tshuam ntxiv ntawm cov neeg ua haujlwm kho mob thiab cov nuj nqis ntxiv [12]. Txhawm rau txo qis qhov kev pheej hmoo ntawm kev mob qog nqaij hlav hauv cheeb tsam, cov tshuaj tiv thaiv hauv cheeb tsam nrog citrate lossis heparin (unfractionated heparin (UFH) lossis qis molecular hnyav heparin) lossis cov kab mob anticoagulation (UFH, qis molecular hnyav heparin, lossis prostacyclin) yog siv [13]. Nyob rau hauv cov ntaub ntawv ntawm nquag circuit clotting, lub teb chaws cov txheej txheem luam tawm nyob rau hauv teb chaws Askiv qhia cov hauv qab no: vascular mus kom ze optimization, xav txog lwm txoj kev/combined anticoagulant cov tswv yim xws li ua ke citrate thiab heparin (systemic los yog hauv Circuit Court), heparin thiab epoprostenol los yog argatroban yog tias lwm yam kab mob prothrombotic raug cais tawm. [14].
Txoj kev tshawb no yog tsom mus rau cov ntsiab lus ntawm kev kho mob hauv kev kho mob ntawm COVID-19- koom nrog AKI los ntawm kev hloov pauv ntawm CRRT nrog rau kev tsom mus rau tus nqi ntawm cov tshuaj UFH.
Herba Cistanche
Txoj kev
Txoj kev tshawb no suav nrog 276 tus neeg mob uas muaj COVID-19 mob ntsws uas tau kho ntawm Lub Tsev Kho Mob rau Kab Mob Sib Kis, Chaw Kho Mob ntawm Vojvodina txij lub Peb Hlis, 6 txog Lub Tsib Hlis 20, 2020. Ntawm cov ntawd, 12 tus neeg mob laus tau kho nrog CRRT vim yog COVID. -19- koom nrog AKI. Xya ntawm lawv (58.3 feem pua) tau tsim AKI hauv ntau lub cev tsis ua haujlwm thiab raug kho hauv ICU, thaum tsib (41.7 feem pua) tau kho hauv chav saib xyuas ib nrab.
Txoj kev tshawb no tau pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Ncaj Ncees ntawm Lub Chaw Kho Mob ntawm Vojvodina.
Peb txheeb xyuas: cov ntaub ntawv pej xeem; comorbidities; kuaj thiab kuaj tsis tau 24 teev ua ntej thiab tom qab CRRT; simplified physiology qhab nia (SAPS II) thiab hloov cov qhab nia ceeb toom ntxov (MEWS); muaj mob ua pa nyuaj (ARDS) thiab kis kab mob thib ob; qhov xav tau kev txhawb nqa ntau yam hauv nruab nrog cev, ntxeem tau MV, tsis muaj qhov cua nkag mus, siab ntws qhov ntswg cannula; Padua Prediction Score for Risk of VTE, ib koob tshuaj thromboprophylaxis; pib ntawm CRRT txij thaum nkag, anuria ua ntej CRRT, CRRT modalities, hom adsorptive membrane, ib koob ntawm CRRT (ml / kg / h), tiav ultrafiltration thaum lub sij hawm CRRT (ml), bolus koob tshuaj (IU) thiab tas mus li koob tshuaj (IU / kg. /h) ntawm UFH thaum CRRT; tus naj npawb ntawm cov txheej txheem ntawm CRRT; kev kho mob tau txais los ntawm cov neeg mob, qhov ntev ntawm kev mus pw hauv tsev kho mob thiab kev tuag.
Tus qhab nia SAPS II muaj 12 qhov sib txawv ntawm lub cev thiab peb qhov sib txawv ntawm cov kab mob uas tau sau tseg hauv thawj 24 teev ntawm kev nkag mus rau ICU. SAPS II cov qhab nia yuav txawv ntawm 0 thiab 163 cov ntsiab lus (0-116 cov ntsiab lus rau lub cev hloov pauv, 0-17 cov ntsiab lus rau hnub nyoog, thiab 0-30 cov ntsiab lus rau yav dhau los kuaj mob). MEWS cov qhab nia yog raws li plaub tus qauv physiological variables thiab AVPU kev soj ntsuam kev nco qab (ceeb toom, suab teb, mob teb, tsis teb). Lub hom phiaj tseem ceeb ntawm MEWS yog los tiv thaiv kev ncua sij hawm ntawm kev cuam tshuam lossis hloov cov neeg mob hnyav. Qhov qhab nia Ntau dua lossis sib npaug li 5 yog qhov txheeb cais nrog qhov muaj feem ntau ntawm qhov tshwm sim tuag lossis nkag mus rau ICU.
Cov txheej txheem rau kev pib CRRT raws li Kab Mob Raum Txhim Kho Kev Txhim Kho Ntiaj Teb yog cov theem 2 lossis 3 AKI.
CRRT tau ua tiav ntawm ob lub cuab yeej uas muaj nws cov lim dej: Multifilter (high-flux lim Kit8 CVVHDF 1000, Bad Homburg, Lub teb chaws Yelemees) thiab Prismaflex (high-flux lim ST150 Gambro, Deerfield, IL, USA). EMiC2 Hemofilter (Fresenius Medical Care, Bad Homburg, Lub teb chaws Yelemees, 1.8 m2 deg cheeb tsam) thiab Osiris (Gambro, AN{9}} raws li daim nyias nyias, nto kho los ntawm polyethyleneimine thiab grafted nrog heparin) tau muab rau cov neeg mob septic.
Kev txheeb cais
Cov txheej txheem piav qhia thiab inferential statistical tau siv rau kev txheeb xyuas cov ntaub ntawv. Cov yam ntxwv ntawm tus lej raug nthuav tawm los ntawm tus lej lej, qhov nruab nrab nrog qhov sib txawv ntawm qhov sib txawv (IQR 25-75 feem pua), thiab tus qauv sib txawv, thaum cov yam ntxwv ntawm tus cwj pwm tau qhia los ntawm ntau zaus thiab feem pua. Muab qhov piv txwv loj, piv txwv li, tsawg zaus los sib piv qhov sib txawv ntawm cov pab pawg, Wilcoxon test rau cov qauv ua ke tau siv, ib qho kev xaiv rau Cov Tub Ntxhais Kawm T-test rau ob qho piv txwv. Muaj qhov tseem ceeb ntawm kev txheeb cais yog p < 0.05, thiab qhov tseem ceeb ntawm cov ntaub ntawv yog p < 0.001. IBM SPSS Statistical Package for Social Sciences 21 software pob tau siv los ua cov ntaub ntawv txheeb cais.
Cistanche tubulosa
Kev sib tham
Ntxiv rau cov kab mob hemostatic, immobility, thiab kab mob hauv lub cev, MV thiab lub hauv paus catheters ua rau muaj kev pheej hmoo ntawm VTE hauv ICU. Kev noj zaub mov tsis zoo thiab lub siab ua haujlwm tsis zoo tuaj yeem cuam tshuam nrog kev sib txuas ntawm coagulation yam. Vim lub cev tsis ua haujlwm, cov neeg mob hnyav tau hloov pauv hauv cov tshuaj pharmacokinetics, uas yuav tsum tau hloov kho cov tshuaj anticoagulant [15]. Peb cov neeg mob muaj ntau theem ntawm D-dimer nyob ntawm qhov hnyav ntawm lawv qhov chaw kho mob thiab cov kab mob thib ob. Lawv muaj cov teeb meem me me ntawm cov txheej txheem hemostasis yam tsis tau tsim kev nthuav tawm intravascular coagulation raug txheeb xyuas, uas sib raug rau cov txiaj ntsig ntawm kev tshawb fawb Dutch [16]. Siv Padova Prediction Score for Risk of VTE, qhov kev pheej hmoo siab dua lossis sib npaug ntawm 4 tau txiav txim siab hauv 75 feem pua, piv txwv li, cuaj tus neeg mob, (xya tus neeg mob hnyav thiab ob leeg tau kho hauv ib nrab kev saib xyuas). Tsis zoo li lwm cov kev tshawb fawb luam tawm, tsis muaj tus neeg mob tsim muaj qhov tshwm sim thrombotic [16, 17, 18]. Namely, cov kws sau ntawv ntawm Dutch txoj kev tshawb fawb tau tshaj tawm tias 31 feem pua ntawm 184 COVID-19 cov neeg mob muaj cov kab mob hauv cov hlab ntsha thiab cov hlab ntsha, txawm tias txhua tus neeg mob muaj tus qauv thromboprophylaxis [16]. Cov kws sau ntawv ntawm lwm txoj kev tshawb fawb kuj tau siv cov qhab nia Padova thiab pom tias 40 feem pua ntawm cov neeg mob muaj kev pheej hmoo rau VTE, txawm hais tias txoj kev tshawb no tsis tau muab cov ntaub ntawv ntawm kev siv VTE prophylaxis lossis ib qho xwm txheej nrog VTE [18]. Hauv ob lub Fabkis ICUs, tag nrho tus nqi ntawm VTE hauv cov neeg mob tau pom tias yog siab heev ntawm 69 feem pua, tab sis tsuas yog 31 feem pua ntawm lawv tau kho nrog prophylactic anticoagulation [17].
Peb cov neeg mob muaj kev pheej hmoo rau kev tsim AKI vim tias muaj cov kab mob sib kis ntau tshaj plaws xws li kub siab, mob raum tsis ua haujlwm, ntshav qab zib, thiab kab mob plawv, siv cov tshuaj diuretics thiab ACE inhibitors, uas sib haum nrog cov ntawv luam tawm ntawm lwm tus kws sau ntawv [19] . Qhov pib ntawm qee txoj hauv kev CRRT raug soj ntsuam tus kheej raws li kev soj ntsuam thiab kuaj ntsuas, los ntawm cov lus qhia tam sim no. Piv nrog rau cov cim CRRT ib txwm muaj nyob rau hauv cov neeg mob uas muaj qhov pib ntawm AKI, qhov kev coj ua yog hypervolemia rau kev ua pa. Txhua tus neeg mob muaj ob-lumen catheter tso rau hauv txoj cai sab hauv jugular leeg, los ntawm cov lus pom zoo [20].
Nyob ntawm qhov muaj cov qauv, muab cov khoom siv lim ntshav, cov khoom siv lim dej, thiab cov cytosorber, cov lus pom zoo rau cov neeg mob hnyav yog CVVH lossis CVVHDF lub hom phiaj ntawm kev xa khoom tsawg kawg yog 20-25 mL / kg / h [21]. Nyob rau lub sijhawm kawm, hauv COVID-19- tau lees paub cov neeg mob xav tau cov txheej txheem lim ntshav, peb tuaj yeem npaj tsuas yog kev siv CRRT nrog heparin anticoagulation, nrog rau qhov tseem ceeb ntawm pre-dilution CVVHDF thiab cov ntaub so ntswg heev (oXiris, EMiC2) hauv cuaj (75 feem pua) cov neeg mob uas muaj cov kab mob proinflammatory siab. Hauv cov neeg mob no, CRRT koob tshuaj yog 35-40 mL / kg / h kom tshem tawm cov kab mob sib kis, thaum lwm tus neeg mob uas lub hom phiaj tseem ceeb yog kev saib xyuas ntim muaj CRRT 25-30 mL / kg / h. Thaum cov txheej txheem, cov tshuaj tua kab mob tau hloov kho thiab lub zog yuav tsum tau nce ntxiv los ntawm 20-30 (kcal / kg.d), protein 1.5 Tsawg dua lossis sib npaug rau 1.7 (g kg.d), thiab amino acids 1.5 Tsawg dua. los yog sib npaug rau 1.7 (g kg.d) raws li kev kho mob tus kheej [22].
Txog tam sim no, cov ntaub ntawv hais txog kev lim dej ua ntej lub sijhawm ntxov tau luam tawm ntau zaus. Nyob rau hauv ib lub koom haum Fab Kis ntau ntawm 150 tus neeg mob, 29 ntawm lawv tau kho rau RRT thiab 28 ntawm lawv (97 feem pua) tau ntsib cov kab mob thrombosis, nrog rau lub neej luv luv ntawm Circuit Court [9]. Lub anticoagulation ntawm Circuit Court tsis tau txheeb xyuas tshwj xeeb, txawm li cas los xij, tag nrho cov neeg mob tau txais tsawg kawg yog thromboprophylaxis, thiab 30 feem pua ntawm lawv tau kho cov tshuaj heparin. Hauv kev tshawb fawb ntxiv hauv ib lub chaw nrog 69 tus neeg mob hnyav nrog COVID-19, cuaj ntawm 11 tus neeg mob tau nce kev kho UFH infusions vim thrombosis ntawm lub voj voog rov tshwm sim [23]. Ib txoj kev tshawb fawb thib peb hauv unicenter tau tshaj tawm cov lim dej coagulation hauv yim ntawm 12 tus neeg mob hnyav nrog COVID-19 ntawm hemofiltration, txawm tias muaj tshuaj tiv thaiv coagulation nrog cov tshuaj tiv thaiv kab mob. Tawm ntawm plaub tus neeg mob uas tsis muaj lim ntshav, peb tau nyob rau hauv kev kho mob UFH infusion vim muaj thrombosis uas twb muaj lawm thaum lub sij hawm ntawm hemofiltration pib [24].
Cistanche capsules
Qhov zoo tshaj plaws anticoagulant lub tswv yim los tiv thaiv Circuit Court coagulation thiab xyuas kom meej tias CRRT kev ua tau zoo yog tsis paub nyob rau hauv COVID-19. Txij li thaum 75 feem pua ntawm peb cov neeg mob muaj qhov qhab nia Padua Ntau dua lossis sib npaug rau 4, txhawm rau ua kom lub neej lim ntev, ua ntej dilution CVVHDF nrog cov tshuaj tiv thaiv kab mob oXiris membrane tau siv rau hauv 58.3 feem pua ntawm cov neeg mob hnyav uas muaj cov kab mob siab thiab D-dimer. Wen et al. [25] tsis tau txiav txim siab qhov kev sib raug zoo ntawm D-dimer qhov tseem ceeb thiab txo qis cov kev lim ntshav qis qis hauv ib ncig ntawm 30 feem pua ntawm cov neeg mob, sib piv nrog txoj kev tshawb fawb ua los ntawm Valle li al. [26], leej twg tau ua pov thawj tias qib siab dua ntawm D-dimer qhia tias muaj ntau dua ntawm cov lim coagulation hauv CRRT hauv 46.6 feem pua ntawm cov neeg mob. Txawm li cas los xij, cov txiaj ntsig tsis sib piv vim qhov qis dua ntawm D-dimer, kev kho mob sib txawv, thiab tsis muaj cov ntsiab lus ntawm coagulation hauv thawj txoj kev tshawb fawb. Tsis tas li ntawd, tsis muaj kev tshawb fawb soj ntsuam Anti-Xa thiab txiav txim siab antithrombin III thiab yam VIII. Kev sib raug zoo ntawm cov txiaj ntsig siab dua ntawm CRP nrog lub sijhawm luv luv ntawm kev lim ntshav qis qis tau txiav txim siab hauv thawj txoj kev tshawb fawb, uas qhia txog kev sib raug zoo ntawm cov kab mob hyperinflammation hauv COVID-19 cov neeg mob thiab coagulation ntawm extracorporeal circuits. Kev nce qib CRP nyob rau theem mob hnyav yog cuam tshuam nrog hyperviscosity, thiab tom kawg tau kuaj pom nyob rau hauv cov neeg mob hnyav COVID-19 [27, 28]. Peb txoj kev tshawb fawb tsis tau txheeb xyuas qhov kev sib raug zoo ntawm D-dimer thiab CRP nrog cov lim coagulation vim qhov kev faib ua feem ntawm cov qauv, thiab qhov tseeb tias tsuas yog ib tus neeg mob muaj cov kab mob sib kis.
Qhov pom zoo pib koob tshuaj UFH yog 10–15 IU / kg ib teev twg thiab aPTT yog 60–90 vib nas this [21]. Hauv peb txoj kev tshawb fawb, hauv rau tus neeg mob (50 feem pua) qhov tseem ceeb ntawm hemostasis tsis thiab platelets tau tso cai thawj zaug nce los ntawm 1/3 txog 1/2 ntawm qhov pom zoo bolus koob tshuaj UFH, thiab peb tau nce UFH koob tshuaj kom txog thaum peb mus txog lub hom phiaj qhov tseem ceeb. ntawm aPPT li 180-220 vib nas this. Txawm hais tias kev tswj hwm cov koob tshuaj ntau dua ntawm UHF, thaum lub sijhawm CRRT tag nrho rau tus neeg mob yuav tsum tau txhaj tshuaj ntxiv, nrog rau ob tus neeg mob (nrog rau tus kab mob malignant) tau kho hauv chav kho mob phais mob hnyav uas siv cov ntaub so ntswg EMiC2. Hauv qhov xwm txheej ntawm kev siv ECMO ntxiv rau CRRT cov ntshav ntws tau tswj hwm ntawm> 400 ml / min [29]. Tus neeg mob uas tau txais ECMO ntxiv rau CVVHDF tau muab tshuaj UFH raws li cov lus qhia ntawm cov neeg mob uas tsis yog-COVID-19 [30].
Tsis muaj ntshav, tsis muaj heparin tsis kam, thiab tsis muaj heparin-induced thrombocytopenia nyob rau hauv ib qho ntawm cov neeg mob. Txawm li cas los xij, CRRT raug txiav tawm hauv ib tus neeg mob vim yog lub voj voog txhaws, yog li ntawd, cov koob tshuaj tau nce mus rau qhov txwv siab ntawm thromboprophylaxis txhawm rau tiv thaiv cov hlab ntsha rov qab.
Txog thaum peb tau txais cov lus pom zoo ntau dua ntawm tus nqi ntawm bolus thiab koob tshuaj txuas ntxiv ntawm UFH rau COVID-19 cov neeg mob, ib tus yuav tsum tau ua tib zoo xav txog comorbidities, koob tshuaj ntawm thromboprophylaxis, hom RRT modalities thiab cov ntaub so ntswg adsorptive heev, lub sijhawm npaj. ntawm cov txheej txheem thiab qib ntawm ultrafiltration.
Thaum lub sij hawm ntxov tshaj plaws ntawm kev sib kis, ob tus neeg mob tau kho nrog tshuaj tua kab mob (Lopinavir / Ritonavir), thiab ob leeg tau noj azithromycin thiab corticosteroids hauv cov koob tshuaj pom zoo [5]. Hydroxychloroquine tau qhia hauv peb tus neeg mob. Nws paub tias cov tshuaj no tuaj yeem muaj cov nyhuv antithrombotic, tshwj xeeb tshaj yog ntawm cov tshuaj tiv thaiv kab mob antiphospholipid, uas peb tsis tuaj yeem txheeb xyuas thaum muaj kev sib kis. Ob tus neeg mob tau siv tshuaj tiv thaiv kab mob thiab tshuaj tiv thaiv kab mob rau cov kab mob coronary mob thiab atrial fibrillation ua ntej COVID-19.
Lub sijhawm nruab nrab ntawm kev mus pw hauv tsev kho mob ntawm peb cov neeg mob uas xav tau CRRT yog 14.92 ± 10.90 hnub, zoo ib yam li qee cov ntaub ntawv luam tawm [31]. Kev tuag yog 75 feem pua , thaum nyob rau hauv cov kev tshawb fawb ua tiav, nws nyob nruab nrab ntawm 63.3-90 feem pua [32, 33, 34].
Muaj qee qhov kev txwv cuam tshuam nrog peb txoj kev kawm. Qhov no yog ib qho kev tshawb fawb hauv ib qho chaw, suav nrog qee tus neeg mob tsawg thaum lub sijhawm luv. Tag nrho peb cov neeg mob tau kho nrog CRRT, tsis muaj pawg tswj hwm vim muaj cov ntaub ntawv tsawg, thiab peb tsis muaj kev nkag siab txog qhov tshwm sim ntawm AKI hauv cov neeg mob kho nrog kev saib xyuas kev kho mob.
Cistanche extract
TEEB MEEM
Kev siv ua ntej-dilution CVVHDF nrog antithrombin membrane thiab UFH koob tshuaj ntau dua los ntawm 1/3 txog 1/2 dua li cov lus pom zoo, tau txuas ntxiv lub neej lim tsis muaj teeb meem hauv peb cov neeg mob COVID-19 uas muaj cov kab mob siab thiab D- dimer thiab kwv yees qhov kev pheej hmoo ntawm kev tsim cov hlab ntsha sib sib zog nqus thrombosis. Qhov xav tau kev sib koom ua ke hauv kev kuaj mob thiab kev kho kom zoo ntawm AKI nrog kev nkag siab zoo dua ntawm COVID-19 yuav pab txiav txim siab txoj hauv kev zoo rau CRRT hauv cov neeg mob no.
REFERENCES
1. Peerapornratana S, Manrique-Caballero CL, Gómez H, Kellum JA. Mob raum raug mob los ntawm sepsis: cov ntsiab lus tam sim no, kab mob sib kis, pathophysiology, kev tiv thaiv, thiab kev kho mob. Raum Int. 2019; 96(5): 1083–99.
2. Chen YT, Shao SC, Hsu CK, Wu IW, Hung MJ, Chen YC. Qhov tshwm sim ntawm mob raum raug mob hauv COVID-19 kev kis kab mob: kev tshuaj xyuas thiab kev tshuaj xyuas meta. Crit Care. 2020; 24(1):346.
3. Rubin A, Orieux A, Prevel R, Garric A, Bats ML, Dabernat S, et al. Tus cwj pwm ntawm Kev mob raum mob hnyav hauv cov neeg mob hnyav nrog tus mob Coronavirus mob hnyav-2019. Clin Kidney J. 2020; 13(3:354–61.
4. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Cov tsos mob ntawm cov neeg mob kis tus kabmob tshiab 2019 hauv Wuhan, Suav. Lancet. 2020; 395 (10223): 497–506.
5. Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, et al. COVID-19 thiab Thrombotic lossis Thromboembolic Disease: Qhov cuam tshuam rau Kev Tiv Thaiv, Kev Kho Mob Ntshav Qab Zib, thiab Ua raws. J Am Coll Cardiol. 2020; 75(23):2950–73.
6. Lippi G, Plebani M, Michael Henry B. Thrombocytopenia cuam tshuam nrog tus kab mob coronavirus hnyav 2019 (COVID-19) kab mob: Kev tshuaj ntsuam meta. Clin Chim Acta. 2020; 5(5):428–30.
7. Zhang C, Shi L, Wang SF. Kev raug mob lub siab hauv COVID-19: kev tswj hwm thiab kev sib tw. Lancet Gastroenterol Hepatol. 2020; 5(5):428–30.
8. Al-Samkari H, Karp Leaf RS, Dzik WH, Carlson JCT, Fogerty AE, Waheed A, et al. COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection. Ntshav. 2020; 136(4): 489–500.
9. Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X, et al. Kev pheej hmoo siab ntawm thrombosis hauv cov neeg mob hnyav SARS-CoV-2 kev kis kab mob: kev tshawb fawb ntau lub zeem muag. Intensive Care Med. 2020; 46(6): 1089–98.
10. Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, et al. Venous thiab arterial thromboembolic teeb meem hauv COVID-19 cov neeg mob tau mus rau hauv tsev kho mob kev kawm hauv Milan, Ltalis. Thromb Res. 2020; 191:9–14.
11. Roberts N. L, Bramham K, Sharpe C. C, Arya R. Hypercoagulability thiab Anticoagulation in Patients With COVID-19 Xav Tau Kev Kho Mob Raum Replacement Therapy. Raum Int Rep. 2020; 5(9): 1377–80.
12. Brandenburger T, Dimski T, Slowinski T, Kindgen-Milles D. Renal replacement therapy and anticoagulation. Qhov Zoo Tshaj Plaws Res Clin Anaesthesiol. 2017; 31(3):387–401.
13. Wu MY, Hsu YH, Bai CH, Lin YF, Wu CH, Tam KW. Regional citrate tiv thaiv heparin anticoagulation rau kev kho mob raum tsis tu ncua: kev tshuaj xyuas meta-kev soj ntsuam ntawm randomized tswj kev sim. Am J Raum Dis. 2012; 59(6:810–8.
14. COVID-19 cov lus qhia ceev ceev: mob raum raug mob hauv tsev kho mob. London: National Institute for Health and Care Excellence (UK); Lub Tsib Hlis 6, 2020. (NICE Guideline, No. 175)
15. Minet C, Potton L, Bonadona A, Hamidfar-Roy R, Somohano CA, Lugosi M, et al. Venous thromboembolism hauv ICU: cov yam ntxwv tseem ceeb, kev kuaj mob, thiab thromboprophylaxis. Crit Care. Xyoo 2015; 19(1): 287.
16. Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, et al. Kev tshwm sim ntawm cov teeb meem thrombotic hauv ICU cov neeg mob hnyav nrog COVID-19. Thromb Res. 2020; 191:145–7.
17. Llitjos JF, Leclerc M, Chochois C, Monsallier JM, Ramakers M, Auvray M, et al. Kev tshwm sim ntau ntawm venous thromboembolic cov xwm txheej hauv cov neeg mob tiv thaiv kab mob COVID-19 hnyav. J Thromb Haemost. 2020; 18(7):1743–6.
18. Wang T, Chen R, Liu C, Liang W, Guan W, Tang R, et al. Kev ceev faj yuav tsum tau them rau venous thromboembolism prophylaxis hauv kev tswj hwm ntawm COVID-19. Lancet Haematol. 2020; 7(5): e362–e363.
19. Guan Wei-Jie, Ni Zheng-yi, Hu Yu, Liang Wen-hua, Ou Chun-quan, He Jian-xing, et al. Cov yam ntxwv kho mob ntawm 2019 tus kab mob coronavirus tshiab hauv Suav teb. N Engl J Med. 2020; 382: 1708–20.
20. Song JC, Wang G, Zhang W, Zhang Y, Li WQ, Zhou Z, et al. Suav cov kws tshaj lij pom zoo rau kev kuaj mob thiab kev kho mob ntawm coagulation dysfunction hauv COVID-19. Mil Med Res. Xyoo 2020; 7(1): 19.
21. Ronco C, Reis T, Husain-Syed F. Kev tswj cov mob raum raug mob rau cov neeg mob COVID-19. Lancet Respir Med. 2020; 8(7):738–42.
22. Gao S, Xu J, Zhang S, Jin J. Meta-Kev soj ntsuam ntawm lub koom haum ntawm Fibroblast Growth Factor 23 thiab Mortality and Cardiovascular Events in Hemodialysis Patients. Ntshav Purif. 2019; 47(Suppl 1): 24–30.
23. White D, MacDonald S, Bull T, Hayman M, de Monteverde-Robb R, Sapsford D, thiab al. Heparin tsis kam nyob rau hauv COVID-19 cov neeg mob hauv chav kho mob hnyav. J Thrombolysis ntawm Thrombolysis. 2020; 50(2): 287–91.
24. Al-Samkari H, Karp Leaf RS, Dzik WH, Carlson JCT, Fogerty AE, Waheed A, et al. COVID thiab coagulation: los ntshav thiab thrombotic tshwm sim ntawm tus kab mob SARS-CoV2. Ntshav. 2020; 136(4): 489–500.
25. Wen Y, LeDoux JR, Mohamed MMB, Ramanand A, Scharwath K, Mundy D, et al. Dialysis lim lub neej, anticoagulation, thiab o hauv COVID-19 thiab mob raum raug mob. Lub raum 360. 2020; 1(12):1426–31.
26. Valle EO, Cabrera CPS, Albuquerque CCC, Silva GVD, Oliveira MFA, Muag GTM, thiab al. Kev kho lub raum tsis tu ncua hauv COVID- 19- koom nrog AKI: ntxiv cov tshuaj heparin rau citrate txhawm rau txuas lub neej lim dej-ib txoj kev tshawb fawb rov qab. Crit Care. 2021; 25(1): 299.
27. Nwo EU. Tag nrho cov ntshav viscosity ntsuam xyuas teeb meem IV: Prevalence nyob rau theem mob o. N Am J Med Sci. 2010; 2(8):353–8.
28. Maier CL, Truong AD, Auld SC, Polly DM, Tanksley CL, Duncan A. COVID-19-sociated hyperviscosity: kev sib txuas ntawm qhov mob thiab thrombophilia? Lancet. 2020; 395 (10239): 1758–9.
29. Joannidis M, Forni LG, Klein SJ, Honore PM, Kashani K, Ostermann M, et al. Kev sib cuam tshuam hauv lub raum hauv lub raum hauv cov neeg mob hnyav: daim ntawv tshaj tawm pom zoo ntawm Cov Kab Mob Zoo Tshaj Plaws (ADQI) 21 Workgroup. Intensive Care Med. 2020; 46(4): 654–72.
30. Colman E, Yin EB, Laine G, Chatterjee S, Saatee S, Herlihy JP, et al. Kev ntsuam xyuas ntawm heparin soj ntsuam raws tu qauv rau extracorporeal membrane oxygenation thiab tshuaj xyuas cov ntaub ntawv. J Thorac Dis. 2019; 11(8):3325–35.
31. Gündoğan K, Temel S, Ketencioğlu BB, Rabah B, Tutar N, Sungur M. Acute Kidney Injury in SARS-CoV-2 Infected Critically Ill Patients 2020. Turk J Nephrol. 29(3):185–9 : kuv.
32. Gupta S, Coca SG, Chan L, Melamed ML, Brenner SK, Hayek SS, et al. AKI kho nrog raum hloov kho hauv cov neeg mob hnyav nrog COVID-19. J Am Soc Nephrol. 2021; 32(1): 161–76.
33. Zhou S, Xu J, Xue C, Yang B, Mao Z, Ong ACM. Cov txiaj ntsig ntawm lub raum cuam tshuam rau tus mob coronavirus hauv COVID-19, SARS, thiab MERS: kev tshuaj ntsuam xyuas thiab kev tshuaj xyuas zoo. Ren Fail. 2020; 43(1):1–15.
34. Bezerra R, Teles F, Mendonca PB, Damte T, Likaka A, Ferrer-Miranda E, et al. Cov txiaj ntsig ntawm cov neeg mob hnyav nrog mob raum raug mob hauv COVID-19 kev kis kab mob: kev tshawb fawb soj ntsuam. Ren Fail. 2021; 43(1):911–8.
Violeta Knežević1,2, Tijana Azaševac1,2, Gordana Stražmešter-Majstorović1,2, Mira Marković1, Maja Ružić2,3, Vesna Turkulov2,3, Nataša Gocić4, Dragana Milijašević2,2eĆĆĆć
1 Clinical Center of Vojvodina, Clinical Nephrology and Clinical Immunology, Novi Sad, Serbia;
2 University of Novi Sad, Kws Qhia Ntawv ntawm Tshuaj, Novi Sad, Serbia;
3 Clinical Center of Vojvodina, Tsev Kho Mob rau Kab Mob Sib Kis, Novi Sad, Serbia;
4 Clinical Center of Vojvodina, Emergency Center, Novi Sad, Serbia;
5 Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv ntawm Vojvodina, Novi Sad, Serbia
