在需要静脉-动脉外体膜氧化的儿童中,自主功能和大脑和体质氧化与动脉流动脉动性的变化
Brian Appavu1, Elise Dunning2, Kara Hildebrandt1
1Barrow Neurological Institute at Phoenix Children's Hospital, Department of Neurosciences, 1919 E. Thomas Road, Ambulatory Building B, 4th Floor, Phoenix, AZ, 85016, USA.
Brain & spine
|March 21, 2024
概括
在儿童的静脉动脉外体膜氧化 (VA-ECMO) 期间,高动脉流脉动性 (AFP) 与自主功能障碍和组织氧化减少有关. 较低的脉动性与巴罗反射敏感性降低和心率增加有关.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 心血管生理学心血管生理学
- 神经监测是指神经系统的监测.
背景情况:
- 静脉动脉外体膜氧化 (VA-ECMO) 是严重的心脏或呼吸系统衰竭的生命支持措施.
- 在VA-ECMO期间动脉流动脉动性 (AFP) 可以显著变化,可能会影响器官输液和功能.
- 了解AFP变化的影响对于优化儿科患者VA-ECMO管理至关重要.
研究的目的:
- 在接受VA-ECMO的儿童中,研究不同水平的动脉流动脉动性 (AFP) 与大脑和体质氧化,血液动力学参数和自主功能变化之间的关联.
- 为了确定与不同AFP水平相关的大脑损伤的潜在风险.
主要方法:
- 一项前性研究涉及53名接受VA-ECMO治疗的儿童,这些儿童接受了神经监测.
- AFP被量化并分为没有,最小,中度和高脉动性.
- 评估了大脑氧度指数 (COx),区域大脑氧化 (rSO2),周边氧和 (SpO2),巴罗反射灵敏度 (BRs),LF/HF比率和心率变化 (HRsd).
- 统计分析包括线性混合效应模型和后勤回归来确定关联和风险.
主要成果:
- 中度至高AFP与rSO2,SpO2和LF/HF比率的降低以及HRsd的增加有关.
- 随着脉动率的增加 (无至最小和最小至中度) 观察到BRs的减少.
- 没有与降低的BRs和动脉血压 (ABP) 相关联的低脉动性,但增加了SpO2和心率. 动脉缺血性中风与较高的AFP有关.
结论:
- 在儿童VA-ECMO期间AFP升高与自主失调有关.
- 脑和体组织氧化的损害随着AFP的增加而发生.
- 在VA-ECMO治疗的儿科患者的管理中,AFP监测可能很重要.
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