儿科患者的急性分区综合征 在体外膜氧化支持的儿科患者中
Callie S Bridges1, Tristen N Taylor1, Thomas Bini2
1Departments of Orthopedics.
Journal of pediatric orthopedics
|December 12, 2023
概括
接受静脉外体膜氧 (VA ECMO) 支持的儿科患者面临急性隔膜综合征 (ACS) 的显著风险,通常在肌肉损伤开始后被诊断出来. 早期识别对于管理这种罕见的并发症至关重要.
科学领域:
- 儿科手术 儿科手术
- 心血管外科心血管外科
- 关键护理医学 关键护理医学
背景情况:
- 急性隔间综合征 (ACS) 是儿科患者罕见但严重的并发症,需要静脉外体膜氧气 (VA ECMO) 支持.
- 仅有有限的数据可以指导这种脆弱人群中ACS的外科治疗.
研究的目的:
- 描述儿童患者的呈现,诊断,时间表和结果,这些儿童患者在VA ECMO支持下开发了 extremity ACS.
- 确定风险因素并评估对这种并发症的干预措施的有效性.
主要方法:
- 一个单一中心的回顾性病例系列进行,涉及VA ECMO支持的儿科患者 (<19岁),他们在2016年1月至2022年12月期间开发了四肢ACS.
- 分析的结果包括带切割的发现,截肢率,死亡率和随访时的功能状态.
主要成果:
- 在343名VA ECMO患者中,18名 (5.2%) 患有ACS,中位数为取消后29小时. 股骨动脉管是显著的风险因素 (OR=6.0).
- 住院死亡率为56%. 14名患者接受了筋切除术,其中64%的肌肉发现不佳,表明诊断延迟.
- 关节切除术的幸存者经历了显著的发病率,包括截肢和收缩;非关节切除术患者的结果也很差.
结论:
- 儿科VA ECMO相关的ACS可以发生在各种管部位,而不仅仅是大腿部.
- 诊断往往是延迟的,发生在肌肉死开始后,带切除术的益处仍然不确定.
- 提高儿童VAECMO患者对ACS的认识和早期识别对于改善结果至关重要.
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