血交换 - - 在患有状细胞病和多器官功能障碍的患者中,红细胞交换是一种有用的辅助疗法
C B Webb1, S G Yates1, R Sarode1,2
1Department of Pathology, University of Texas Southwestern, Dallas, Texas, USA.
Transfusion
|June 15, 2023
概括
治疗性血交换 (TPE) 可能有助于患有状细胞病 (SCD) 和多器官功能障碍综合征 (MODS) 的患者,当红细胞交换 (RBCx) 单独不足时. 在严重的SCD病例中,TPE显示器官功能得分有所改善.
科学领域:
- 血液学 血液学 血液学
- 临界护理医学 临界护理医学
- 重症监护病房 (ICU) 管理管理
背景情况:
- 状细胞疾病 (SCD) 的并发症,如急性胸部综合征和中风,通常需要紧急的红细胞交换 (RBCx).
- 接受RBCx的患者仍然可能患上多个器官功能障碍综合征 (MODS),这是一个在ICU中死亡率高的危急疾病.
- 治疗性血交换 (TPE) 对SCD患者的MODS的有效性,特别是与单独RBCx相比,尚未得到充分证实.
研究的目的:
- 调查治疗性血交换 (TPE) 作为红细胞交换 (RBCx) 的辅助在治疗状细胞病 (SCD) 患者多器官功能障碍综合征 (MODS) 的作用.
- 为了比较结果,包括器官功能得分和死亡率,SCD患者与RBCx治疗的MODS患者之间的RBCx随后的TPE与单独的RBCx.
主要方法:
- 在2013-2019年期间对12次ICU遭遇进行了回顾性审查,其中涉及MODS或SCD危机进展到MODS的RBCx.
- 收集的数据包括停留时间,存活率,RBCx后的TPE手术数量以及序列器官衰竭评估 (SOFA) 评分.
- 末端器官损伤的实验室标志物和疾病严重程度得分在入院时,RBCx后,TPE后和出院时被评估.
主要成果:
- 8名接触者接受了RBCx加TPE (TPE组),而4人仅接受了RBCx (RBCx组).
- TPE组的初始SOFA分数和预测死亡率较高.
- 与RBCx组相比,TPE组的SOFA分数从入院到退院的改善显著更大 (p=0.04).
结论:
- 治疗性血交换 (TPE) 可能是一个有益的辅助治疗状细胞病 (SCD) 患者经历多器官功能障碍综合征 (MODS) 不能充分响应单独的红细胞交换 (RBCx).
- 在MODS复杂化的严重SCD病例中,TPE显示出改善器官功能的潜力.
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