在心脏性休克的VA-ECMO期间的隔膜厚度变化和相关因素:一个队列研究
Pierre-Henri Moury1,2, Alexandre Béhouche3, Sébastien Bailly4
1Pôle Anesthésie-Réanimation, Grenoble Alpes University, Grenoble, France. PHMoury@chu-grenoble.fr.
Annals of intensive care
|March 8, 2024
概括
隔膜缩在静脉动脉外体膜氧化 (VA-ECMO) 患者中很常见,但可以通过早期输出来预防. 在VA-ECMO期间,管理扫除气流和代谢障碍对于隔膜健康至关重要.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统生理学 呼吸系统生理学
- 身体外生命支持器
背景情况:
- 静脉动脉外体膜氧化 (VA-ECMO) 对隔膜厚度的影响尚不清楚.
- 这项研究研究了VA-ECMO在第一周的隔膜厚度变化及其与扫气流的关系.
研究的目的:
- 为了确定腹膜厚度演变的发病率和原因,在接受VA-ECMO治疗心脏性休克的患者中.
- 探索隔膜厚度变化,扫描气体流量和患者结果之间的关系.
主要方法:
- 在ICU中进行了一项前性观察性研究,涉及VA-ECMO的29名患者.
- 隔膜厚度和加厚分数 (dTF) 每天使用超声波测量一周.
- 分析了与隔膜厚度演变,早期排卵和60天结果相关的因素.
主要成果:
- 隔膜缩发生在23%的患者中;早期输出 (在第4天之前) 防止了缩.
- 隔膜厚度变化与扫描气体流量和pH相关,但与dTF无关.
- 低dTF (<20%) 在69%的患者中持续存在,并且与扫气流量有关.
- 隔膜缩在第7天后与60天死亡率增加8.5倍有关.
结论:
- 隔膜厚度的演变在VA-ECMO患者中很常见,不仅仅取决于收缩活性 (dTF).
- 早期的输出似乎可以保护隔膜缩.
- 扫除气体流和代谢干扰与隔膜厚度的变化有关,突出了需要保护策略的需要.
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