EKMO’da Hemofiltrasyon ve Hemodiyaliz
Peryüzyonist Aydın BİLGİLİ
GATA, Kalp Damar Cerrahisi AD, Perfüzyon Bölümü, Ankara
Özet
Günümüzde tüm hastane başvurularının %1-5’inde ve yoğun bakım hastalarının %30’unda akut böbrek yetmezliği (ABY) görülmektedir. Özellikle kardiyak cerrahi yapılacak hastalar, operasyon sonrası ABY gelişimi açısından risk altındadırlar. ABY, %4-13 aralığında çoklu organ yetmezliğine yol açmakta ve bu hastalarda mortalite %0,6-100 gibi yüksek bir orana çıkmaktadır. ABY, ekstrakorporal membran oksijeni-zasyonu (EKMO) uygulanan hastalarda %12-69 aralığında görülmektedir ve mortalite açısından bağımsız bir risk faktörü olarak düşünülmelidir. Renal replas-man tedavi yöntemlerinin seçimi, klinik tecrübelere ve lokal uygulamalara bağlıdır. Uygulanan yöntemlere bağlı olarak amaç, böbrek yetmezliği olan hastada serum elektrolitlerinin tam kontrolünü, toksinlerin ve fazla sıvının uzaklaştırılmasını sağla-maktır. Açık kalp cerrahisinde hemofiltrasyon, renal yetmezliği olan hastalarda sıvı ve elektrolit dengesini sağlamaya yönelik olarak kullanılmaya başlanmıştır ve akciğer, böbrek, beyin ve kalp fonksiyonlarında olumlu değişikliklere yol açmak-tadır. Hemodiyaliz ise akut ve kronik renal yetmezlikli hastalarda gerekli olabilmek-tedir. Hastalık sürecinin ciddiyetine bağlı olarak EKMO hasta grubunda sıvı ve elektrolit dengesizliği yaygındır. Renal replasman tedavi yöntemlerinin kullanılması hastanın hayatta kalma oranını artırabilir.
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