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高风险肺栓塞的静脉ECMO前血栓溶解:一个回顾性队列研究
David Levy1,2, Ouriel Saura1,2, Maria Teresa Passarelli2,3
1Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France.
Intensive care medicine
|June 24, 2024
概括
在高风险肺栓塞 (PE) 进行静脉外体膜氧化 (VA-ECMO) 之前的全身血栓溶解没有影响90天的生存或出血风险. 最近的血栓溶解不应该在这些严重的PE患者中禁忌VA-ECMO.
科学领域:
- 心脏病学 心脏病学
- 密集护理医学 密集护理医学
- 肺部医学 肺部医学
背景情况:
- 高风险的肺栓塞 (PE) 尽管有系统性血栓溶解,但可能导致血液动力学不稳定.
- 静脉外体膜氧化 (VA-ECMO) 是不稳定的PE患者的关键干预措施.
- 人们担心VA-ECMO在全身血栓溶解后出现出血风险增加.
研究的目的:
- 为了比较使用VA-ECMO治疗的高风险PE患者的ECMO相关并发症和90天死亡率.
- 为了评估接受VA-ECMO与或没有先前系统性血栓溶解的患者的结果.
- 评估VA-ECMO在PE患者最近发生血栓溶解的安全性和有效性.
主要方法:
- 从2012年6月到2023年6月接受VA-ECMO的72名高风险PE患者的回顾性分析.
- 对接受ECMO前血栓溶解 (T+) 和未接受 (T-) 患者的结局结果进行比较.
- 评估90天死亡率,严重出血率和长期生活质量.
主要成果:
- 血栓溶解 (39%) 和无血栓溶解 (46%) 组之间90天生存时间没有显著差异 (p=0.31).
- 在两组中,严重出血的发生率相似 (61%对59%,p=1).
- 长期随访显示了可接受的生活质量,没有慢性血栓栓塞性肺高血压病例.
结论:
- 在VA-ECMO之前的全身血栓溶解不会对高风险PE患者的90天生存率或出血并发症产生不利影响.
- 最近的全身血栓溶解不应该是VA-ECMO治疗的绝对禁忌.
- 对于血液动力学不稳定的PE患者来说,VA-ECMO是一个可行的选择,即使在血栓溶解失败后也是如此.
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