在体外膜氧化期间的电路变化:对48个变化的单中心回顾性研究
Thibaut Genty1, Stanislas Burguburu2, Audrey Imbert2
1Cardiothoracic Intensive Care Unit, Hôpital Marie LannelongueGroupe Hospitalier Paris Saint Joseph, 133 Avenue de La Résistance, 92350, Le Plessis-Robinson, France. t.genty@ghpsj.fr.
Critical care (London, England)
|June 2, 2023
概括
在患有严重出血的患者中改变体外膜氧化 (ECMO) 电路可以通过减少出血和输血需求来改善结果. 这种干预也增加了血小板和纤维素原水平,有助于恢复.
科学领域:
- 临界护理医学 临界护理医学
- 心血管外科心血管外科
- 血液学 血液学 血液学
背景情况:
- 身体外膜氧化 (ECMO) 与出血和血栓形成的重大风险有关.
- 目前的指导方针不建议ECMO电路更改用于流血管理.
- 了解电路更改对临床和实验室参数的影响至关重要.
研究的目的:
- 评估ECMO电路更改前后的临床,实验室和输血参数.
- 为了比较患者进行循环改变为出血与血栓形成的结果.
- 评估电路变化对死亡率和特定临床指标的影响.
主要方法:
- 从2017年1月到2020年8月,对274名ECMO患者进行了一项回顾性单中心队列研究.
- 收集了关于临床 (出血,静血,氧化,输血) 和实验室 (血小板,血红蛋白,纤维素素,PaO2) 参数在七天内围绕电路变化的数据.
- 分析了44名患者的48个电路变化,按指示分层 (32次出血,16次血栓形成).
主要成果:
- 患有电路变化和没有电路变化的患者 (48%与43%),以及出血和血栓症迹象 (43%与56%之间) 的死亡率相似.
- 在出血患者中,电路变化显著减少了出血事件,静血手术和红细胞输血 (P < 0.001).
- 流血患者在循环改变后的血小板数量和纤维素水平增加,而氧化参数保持不变.
结论:
- 改变ECMO电路可以有效地控制严重出血,减少输血需求和改善血液学参数.
- 血栓形成的电路变化没有显著改变出血事件或输血需求.
- 在这两组中,氧化参数和ECMO流量都没有受到电路变化的显著影响.
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