{"id":624,"date":"2017-09-02T23:47:07","date_gmt":"2017-09-02T20:47:07","guid":{"rendered":"https:\/\/tatd.org.tr\/tatdtoks\/2021\/09\/15\/zehirlenmelerde-ekstrakorporeal-tedaviler-yazi-dizisi-genel-yaklasim\/"},"modified":"2021-11-10T22:35:24","modified_gmt":"2021-11-10T19:35:24","slug":"zehirlenmelerde-ekstrakorporeal-tedaviler-yazi-dizisi-genel-yaklasim","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/toksikoloji\/2017\/09\/02\/zehirlenmelerde-ekstrakorporeal-tedaviler-yazi-dizisi-genel-yaklasim\/","title":{"rendered":"Zehirlenmelerde Ekstrakorporeal Tedaviler Yaz\u0131 Dizisi \u2013 Genel Yakla\u015f\u0131m"},"content":{"rendered":"<h2><img decoding=\"async\" style=\"height: 300px;width: 800px\" src=\"https:\/\/tatd.org.tr\/tatdtoks\/wp-content\/uploads\/sites\/36\/2021\/10\/melis1-1.png\" alt=\"\" \/><\/h2>\n<h2><strong>Aral\u0131kl\u0131 hemofiltrasyon (IHF) ve hemodiyafiltrasyon (IHDF)<\/strong><\/h2>\n<ul>\n<li>IHF : konveksiyon tekni\u011fi<\/li>\n<li>IHDF : konveksiyon ve dif\u00fczyon teknikleri bir arada<\/li>\n<li>Konveksiyon =&gt; solvent ve sol\u00fctlerin bas\u0131n\u00e7 fark\u0131 ile hareketi (solvent s\u00fcr\u00fcklenmesi)<\/li>\n<li>Konveksiyonda s\u0131v\u0131 hemostaz\u0131n\u0131n sa\u011flanmas\u0131 i\u00e7in hastaya \u00f6zel bir replasman s\u0131v\u0131s\u0131 verilir.<\/li>\n<li>Konveksiyon tekni\u011fi ile en az IHD kadar h\u0131zl\u0131 kan ak\u0131m\u0131 sa\u011flanabilir (400 ml\/dk).<\/li>\n<li>Filtre edilebilecek toksin \u00f6zellikleri IHD ile benzer ancak daha b\u00fcy\u00fck molek\u00fcllerin de ge\u00e7i\u015fine olanak verebilir.<\/li>\n<li>Teknik gereksinimleri \u00e7ok, yayg\u0131n de\u011fil.<\/li>\n<\/ul>\n<h2><strong>S\u00fcrekli renal replasman tedavisi (CRRT) ve yava\u015f d\u00fc\u015f\u00fck etkinlikli diyaliz (SLED)<\/strong><\/h2>\n<h3><u>S\u00fcrekli renal replasman tedavisi (CRRT) :<\/u><\/h3>\n<p>&#8211;\u00a0 \u00a0S\u00fcrekli venoven\u00f6z hemodiyaliz (CVVHD)<\/p>\n<p>&#8211;\u00a0 \u00a0S\u00fcrekli venoven\u00f6z hemofiltrasyon (CVVH)<\/p>\n<p>&#8211; \u00a0\u00a0S\u00fcrekli venoven\u00f6z hemodiyafiltrasyon (CVVHDF)\u2019den olu\u015fur.<\/p>\n<p><img decoding=\"async\" style=\"height: 100px;width: 800px\" src=\"https:\/\/tatd.org.tr\/tatdtoks\/wp-content\/uploads\/sites\/36\/2021\/10\/melis2-1.png\" alt=\"\" \/><\/p>\n<ul>\n<li>S\u00fcrekli venoven\u00f6z teknikler, daha g\u00fcvenli olmas\u0131 nedeniyle yerini arterioven\u00f6z tekniklere b\u0131rakm\u0131\u015ft\u0131r.<\/li>\n<li>S\u00fcrekli tekniklerin avantaj\u0131 s\u0131v\u0131 ve sol\u00fctleri uzunca s\u00fcre zarf\u0131nda uzakla\u015ft\u0131rmas\u0131d\u0131r.<\/li>\n<li>IHD, IHF ve IHDF\u2019de kullan\u0131lan teknik s\u00fcrekli replasman tekni\u011fine uygulanabilir ancak ak\u0131m h\u0131z\u0131 d\u00fc\u015f\u00fckt\u00fcr ve klirens daha yava\u015f olmaktad\u0131r.<\/li>\n<\/ul>\n<h3><u>S\u00fcrekli d\u00fc\u015f\u00fck verimli diyaliz (SLED)<\/u><\/h3>\n<ul>\n<li>CRRT\u2019den daha k\u0131sa s\u00fcreli.<\/li>\n<li>Diyalizat ak\u0131m h\u0131z\u0131 CRRT\u2019den daha h\u0131zl\u0131.<\/li>\n<li>Standart IHD ekipmanlar\u0131 kullan\u0131larak uygulanabilir.<\/li>\n<\/ul>\n<h2><strong>Hemoperf\u00fczyon (HP):<\/strong><\/h2>\n<ul>\n<li>Kandaki toksik maddelerin bir kartu\u015ftan ge\u00e7erek filtrelenmesi esas\u0131na dayal\u0131.<\/li>\n<li>Lipofilik ve proteine y\u00fcksek oranda ba\u011flanan bile\u015fiklerin kandan uzakla\u015ft\u0131r\u0131lmas\u0131 daha kolay.<\/li>\n<li>Kartu\u015flar doygunlu\u011fa ula\u015ft\u0131\u011f\u0131ndan 4-6 saatte bir de\u011fi\u015ftirilmesi gerekmekte.<\/li>\n<li>Hemodiyaliz filtre teknolojisinin geli\u015fmesi ile birlikte kullan\u0131m azalm\u0131\u015f.<\/li>\n<li>\u00d6yle ki, kartu\u015flar\u0131 bir\u00e7ok merkezde mevcut de\u011fil.<\/li>\n<\/ul>\n<h2><strong>Terap\u00f6tik plazma de\u011fi\u015fimi (TPE)<\/strong><\/h2>\n<ul>\n<li>Plazman\u0131n v\u00fccut d\u0131\u015f\u0131nda santrif\u00fcj veya filtrasyon ile kan\u0131n h\u00fccresel bile\u015fenlerinden ayr\u0131\u015ft\u0131r\u0131lmas\u0131.<\/li>\n<li>Plazmadan protein dahil t\u00fcm maddeleri ayr\u0131\u015ft\u0131rd\u0131\u011f\u0131 i\u00e7in b\u00fcy\u00fck ve proteine ba\u011flanan toksik maddelerin de uzakla\u015ft\u0131r\u0131lmas\u0131nda faydal\u0131d\u0131r.<\/li>\n<li>Ancak genellikle toksik maddeler k\u00fc\u00e7\u00fck ve orta b\u00fcy\u00fckl\u00fckte oldu\u011fundan, zehirlenmelerde nadiren kullan\u0131l\u0131r.<\/li>\n<li>Amanita phalloides mantar\u0131, tiroksin, vinkristin ve cisplatin i\u00e7in kullan\u0131m\u0131n\u0131 destekleyen yay\u0131nlar mevcuttur.<\/li>\n<\/ul>\n<h2><strong>Alb\u00fcmin diyalizi <\/strong><\/h2>\n<ul>\n<li>Fulminan hepatit veya ciddi sirozda karaci\u011fer nakli \u00f6ncesi karaci\u011fer fonksiyonlar\u0131n\u0131 destekleme ama\u00e7l\u0131 kullan\u0131l\u0131r.<\/li>\n<li>Diyalizat\u0131nda alb\u00fcmin bulunur (proteine ba\u011flanan maddeler i\u00e7in).<\/li>\n<li>Klirens h\u0131z\u0131 t\u00fcm di\u011fer diyaliz y\u00f6ntemlerinden daha yava\u015ft\u0131r.<\/li>\n<li>Zehirlenmelerde kullan\u0131m\u0131 yok. \u00dcst\u00fcnl\u00fc\u011f\u00fc g\u00f6sterilmemi\u015f.<\/li>\n<\/ul>\n<h2><strong>Periton diyalizi <\/strong><\/h2>\n<ul>\n<li>Diyalizat\u0131n periton kavitesine verilerek sol\u00fctlerin konsantrasyon fark\u0131na g\u00f6re kandan diyalizata ge\u00e7mesi (veya tam tersi) prensibine dayan\u0131r.<\/li>\n<li>Kapasitesi zehirlenmeler i\u00e7in k\u0131s\u0131tl\u0131.<\/li>\n<\/ul>\n<h2><strong>De\u011fi\u015fim transf\u00fczyonu <\/strong><\/h2>\n<ul>\n<li>Hastan\u0131n k\u0131rm\u0131z\u0131 kan h\u00fccrelerinin di\u011fer kan bile\u015fenlerinden ayr\u0131larak bunun yerine don\u00f6r k\u0131rm\u0131z\u0131 kan h\u00fccresi verilmesi esas\u0131na dayan\u0131r.<\/li>\n<li>Toksikolojide kullan\u0131m\u0131 : eristrosite ba\u011flanan bile\u015fikler (siklosporin, takrolimus) veya toksik maruziyet (propranil, dapson, anilin, sodyum nitrat) sonras\u0131 geli\u015fen methemoglobinemi.<\/li>\n<\/ul>\n<h2><strong>Yava\u015f devaml\u0131 ultrafiltrasyon (SCUF)<\/strong><\/h2>\n<ul>\n<li>Di\u00fcreti\u011fe yan\u0131ts\u0131z akut konjestif kalp yetmezli\u011fi veya karaci\u011fer yetmezli\u011fi nedeniyle s\u0131v\u0131 y\u00fcklenmesi i\u00e7in.<\/li>\n<li>Sadece s\u0131v\u0131 fazlas\u0131n\u0131 al\u0131r. Zehirlenmelerde yeri yok.<\/li>\n<\/ul>\n<h2><strong>Serebrospinal s\u0131v\u0131 de\u011fi\u015fimi <\/strong><\/h2>\n<ul>\n<li>\u0130ntratekal ila\u00e7 verilmesini (\u00f6r. metotreksat) takiben geli\u015fen n\u00f6rolojik semptomlarda.<\/li>\n<\/ul>\n<p>Yaz\u0131 dizisinin devam\u0131nda, ERCP kullan\u0131m\u0131 ile ilgili literat\u00fcr verilerinin k\u0131s\u0131tl\u0131 ve mevcut \u00e7al\u0131\u015fma sonu\u00e7lar\u0131n\u0131n yorumlanmas\u0131 g\u00fc\u00e7 olan ila\u00e7lar ve maddeler i\u00e7in mevcut verilerle ortak bir konsensus geli\u015ftirmek \u00fczere kurulmu\u015f <em>The EXtracorporeal TReatments In Poisoning<\/em> (EXTRIP) \u00e7al\u0131\u015fma grubunun \u00f6nerilerine yer verece\u011fiz.<\/p>\n<h2>Kaynaklar :<\/h2>\n<ol>\n<li>Ghannoum, M., Bouchard, J., Nolin, T. D., Ouellet, G., &amp; Roberts, D. M. (2014). Hemoperfusion for the Treatment of Poisoning: Technology, Determinants of Poison Clearance, and Application in Clinical Practice. <em>Seminars in Dialysis<\/em>, <em>27<\/em>(4), 350\u2013361. <a href=\"http:\/\/doi.org\/10.1111\/sdi.12246\">http:\/\/doi.org\/10.1111\/sdi.12246<\/a><\/li>\n<li>Ouellet, G., Bouchard, J., Ghannoum, M., &amp; Decker, B. S. (2014). Available Extracorporeal Treatments for Poisoning: Overview and Limitations. <em>Seminars in Dialysis<\/em>, <em>27<\/em>(4), 342\u2013349. <a href=\"http:\/\/doi.org\/10.1111\/sdi.12238\">http:\/\/doi.org\/10.1111\/sdi.12238<\/a><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Genel Yakla\u015f\u0131m<\/p>\n<p>Zehirlenmeler ve toksik ajanlara maruziyet ABD 2012 verilerine g\u00f6re y\u0131ll\u0131k 2.2 milyon ki\u015fiyi ilgilendiriyor. Bu ki\u015filerin yakla\u015f\u0131k \u00bc\u2019\u00fc sa\u011fl\u0131k merkezlerine ba\u015fvurmakta ve bunlar\u0131n da %27\u2019sinde hastane yat\u0131\u015f\u0131 gerekebilmekte. N\u00fcfuslar\u0131n\u0131 orant\u0131lad\u0131\u011f\u0131m\u0131zda T\u00fcrkiye i\u00e7in de durum pek istisna de\u011fil. Genellikle destek ve antidot tedavisi ile y\u00f6netegeldi\u011fimiz bu hadiselerin %0.1\u2019inde ise ekstrakorporeal tedavi (ECTR) modalitelerinden yard\u0131m almaktay\u0131z.<\/p>\n<p>Bu yaz\u0131 dizisinde, kabaca \u201cdiyaliz\u201d olarak k\u0131saltt\u0131\u011f\u0131m\u0131z bu modalitelerin bir k\u0131sm\u0131ndan, ve genel olarak ekstrakorporeal tedavilerin gerekebilece\u011fi zehirlenmelerden bahsedece\u011fiz. Keyifli okumalar.\u00a0<\/p>\n<p>Aral\u0131kl\u0131 hemodiyaliz (IHD)<br \/>\nAkut b\u00f6brek yetmezli\u011fi, son d\u00f6nem b\u00f6brek yetmezli\u011fi ve zehirlenmeler i\u00e7in kullan\u0131lan, en yayg\u0131n y\u00f6ntem.<br \/>\nSol\u00fctlerin yar\u0131 ge\u00e7irgen bir membrandan y\u00fcksek konsantrasyonlu b\u00f6lgeden d\u00fc\u015f\u00fck konsantrasyonda oldu\u011fu b\u00f6lgeye dif\u00fczyonu prensibine dayan\u0131r.<br \/>\nD\u00fc\u015f\u00fck molek\u00fcl a\u011f\u0131rl\u0131kl\u0131 toksinlerin temizlenmesi, elektrolit ve asit baz denge bozukluklar\u0131n\u0131n h\u0131zl\u0131ca d\u00fczeltilmesi, ve s\u0131v\u0131 fazlas\u0131n\u0131n \u00e7ekilmesine olanak verir.<br \/>\nT\u00fcm d\u00fcnyada yayg\u0131n olarak bulundu\u011fu ve kullan\u0131m\u0131 rutin hale geldi\u011finden toksik maddenin h\u0131zl\u0131ca v\u00fccuttan uzakla\u015ft\u0131r\u0131lmas\u0131n\u0131n hayati \u00f6nem arz etti\u011fi durumlarda IHD\u2019nin organize edilip hastan\u0131n tedaviye ula\u015fmas\u0131 daha kolayd\u0131r.<br \/>\nIHD ile uzakla\u015ft\u0131r\u0131lacak toksik maddenin d\u00fc\u015f\u00fck da\u011f\u0131l\u0131m hacmi (VD), d\u00fc\u015f\u00fck protein ba\u011flanma oran\u0131 ve diyaliz membran porlar\u0131ndan daha d\u00fc\u015f\u00fck molek\u00fcler a\u011f\u0131rl\u0131kta (MW) olmas\u0131 beklenir.<br \/>\nYan etki : Kanama ve tromboz<\/p>\n","protected":false},"author":883,"featured_media":1505,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[10014],"tags":[125,140,143,150,449],"class_list":["post-624","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-akademik-blog-yazisi","tag-diyaliz","tag-ekstrakorporeal","tag-ekstrakorporeal-tedaviler","tag-extrip","tag-zehirlenme"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/624","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/users\/883"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/comments?post=624"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/624\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media\/1505"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media?parent=624"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/categories?post=624"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/tags?post=624"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}