在体外膜氧化的出血患者降低了血小板聚合和血纤维素素:一项纵向观察性研究
Christine Lodberg Hvas1,2, Steffen Christensen3,4, Camilla Mains Balle5
1Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark. c.hvas@clin.au.dk.
Scientific reports
|September 4, 2023
概括
身体外膜氧化 (ECMO) 患者表现出低凝血状态. 在ECMO期间的早期出血与纤维素和血小板计数的降低,以及较高的死亡率有关,而不是常规ROTEM®监测.
科学领域:
- 关键护理医学 关键护理医学
- 血液学 血液学 血液学
- 心血管研究研究心血管研究
背景情况:
- 体外膜氧化疗法 (ECMO) 是严重心肺衰竭患者的生命支持措施.
- 凝血障碍,包括出血和血栓形成,是ECMO期间的重大并发症,影响患者的治疗结果.
- 精确的凝血监测对于管理ECMO患者至关重要,但最佳方法仍在争论中.
研究的目的:
- 为了研究成年ECMO患者的凝血变化.
- 检查凝血状态与ECMO期间出血和血栓的发生之间的关联.
- 评估血栓凝聚仪 (ROTEM®) 和标准凝血参数在预测出血事件中的实用性.
主要方法:
- 一项涉及100名成年ECMO患者的前性研究.
- 与健康对照对比标准凝血参数,血小板聚合和旋转性血栓凝结仪 (ROTEM®) 的比较.
- 收集关于出血,血栓和死亡率的数据,直到康复,死亡或断奶后30天.
主要成果:
- 53%的ECMO患者经历了中度至严重的出血,其中79%发生在前1-2天内.
- 与对照组相比,ECMO患者表现出低血凝状态,证据是血小板聚合减少和ROTEM®凝块传播.
- 早期出血 (1至2天) 与血小板数量降低,血小板聚合较差,纤维素素水平降低以及死亡率显著上升 (67%vs. 34%) 相关.
结论:
- 在ECMO期间的早期出血与特定的凝血异常有关,特别是纤维素低,预示着更糟糕的预后.
- 虽然标准测定和ROTEM®显示一致,但血纤维素水平与出血风险的关联比ROTEM®测量更强.
- 目前的研究结果不支持在ECMO患者中常规使用ROTEM®用于凝血监测;血纤维素素可能是一个更关键的参数.
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