血管动脉外体膜氧化在患有心脏性休克的免疫受损患者:一项队列研究和倾向权衡分析
Quentin Moyon1, Félicien Triboulet1, Jean Reuter2
1Assistance Publique des Hopitaux de Paris, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, 75013, Paris, France.
Intensive care medicine
|March 4, 2024
概括
静脉外体膜氧化 (VA-ECMO) 的免疫功能低下患者的治疗结果不佳,死亡率更高. 谨慎的患者选择对于这个面临心脏性休克的脆弱群体至关重要.
科学领域:
- 心脏病学 心脏病学
- 关键护理医学 关键护理医学
- 免疫学 免疫学 免疫学
背景情况:
- 对于接受VA-ECMO治疗的免疫功能低下患者的结局记录不佳.
- 对于这些患者来说,关于ECMO候选人的决定是具有挑战性的.
研究的目的:
- 报告用VA-ECMO治疗的免疫功能低下患者的结果.
- 在这个队列中确定90天死亡率的预测因素.
- 评估免疫抑制对死亡率的影响.
- 描述ECMO相关的并发症.
主要方法:
- 在两个法国ECMO中心进行的回顾性研究.
- 倾向权衡分析,比较免疫受损和非免疫受损患者.
- 从2006年1月到2022年1月收集的数据.
主要成果:
- 177名免疫受损患者接受了VA-ECMO;90天和1年死亡率分别为70%和75%.
- 高龄和更高的乳糖预测死亡率. 免疫抑制独立增加了90天死亡率 (OR 2.53).
- 经常出现出血 (39%) 和传染病 (54%) 的并发症;超过一半的ICU住院涉及抗生素.
结论:
- 免疫功能低下的患者在VA-ECMO治疗中预后不佳.
- 与非免疫功能低下患者相比,观察到更高的90天死亡率.
- 必须对ECMO候选产品进行彻底的评估和仔细的选择.
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