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在新生儿患有先天性腹膜的静脉外体膜氧化过程中的血液溶解:一项前性观察研究

Lotte Lemloh¹, Bartolomeo Bo¹, Hannah Ploeger¹

¹Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany.

The Journal of pediatrics

|September 2, 2023

概括

血液溶解发生在22.6%的新生儿与先天性隔膜 (CDH) 接受体外膜氧化 (ECMO). 这种情况独立地与这些重症婴儿的死亡率增加有关.

科学领域:

新生儿医学新生儿医学
儿科重症监护中心儿童重症监护中心
心血管外科心血管外科

背景情况:

kongenital diaphragmatic hernia (CDH) 是一种严重的疾病,需要先进的呼吸支持.
身体外膜氧化 (ECMO) 是对患有CDH的新生儿的一种拯救生命的疗法,但它存在风险.
血液溶解,红细胞的分解,是ECMO的一个已知的并发症.

研究的目的:

为了确定新生儿中血液溶解的发生率,CDH接受了毒性ECMO治疗.
调查血液溶解与患者结局,特别是死亡率之间的关联.
在这个人群中确定ECMO期间与血液溶解相关的因素.

主要方法:

在62名接受ECMO的CDH新生儿中,对血自由血红蛋白 (PFH) 的前性测量.
血解的定义是PFH≥50 mg/dL至少连续两天.
血液溶解的分类为中度 (50-100毫克/分升) 或严重 (>100毫克/分升).
多变量分析以评估血液溶解和肺高血压与死亡率的独立关联.

主要成果:

在22.6%的患者中检测到血液溶解.
与没有 (31.1%) 的新生儿相比,血液溶解的新生儿的死亡率明显高 (100%) (P < .001).
血液溶解与死亡率 (危险比率:6.8) 和超系统性肺高血压 (危险比率:3.07) 独立相关.
较小的管 (8 Fr) 与较大的管 (13 Fr) 相比,与更高的血液溶解发生率有关.

结论:

血液溶解是CDH新生儿经历毒性ECMO的重大并发症.
血液溶解与这种患者群体的死亡率增加独立相关.
监测PFH并考虑管大小可能对于管理CDH新生儿的ECMO至关重要.

关键词:

生产性腹膜带.身体外生命支持血液溶解 (hemolysis) 是一种血中的自由血红蛋白.这是一种有毒的静脉.

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