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在静脉动脉外体膜氧化支持上部胃肠道出血
Quentin de Roux1,2,3, Yekcan Disli4, Wulfran Bougouin5,6
1Service d'anesthésie-réanimation et médecine péri-opératoire, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France. quentin.deroux@aphp.fr.
Annals of intensive care
|July 3, 2024
概括
上部胃肠道出血 (UGIB) 影响超过10%的静脉动脉外体膜氧化 (V-A ECMO) 患者,增加了资源使用. 预防性治疗,如PPI和肠道营养,在这个高危人群中没有对UGIB产生保护作用.
科学领域:
- 心脏病学 心脏病学
- 关键护理医学 关键护理医学
- 胃肠病学 胃肠病学
背景情况:
- 静脉动脉外体膜氧化 (V-A ECMO) 对于血液动力学支持至关重要,但具有高出血并发症风险.
- 上部胃肠道出血 (UGIB) 是V-A ECMO患者的一个重大问题,影响结果和资源利用.
研究的目的:
- 确定由V-A ECMO支持的患者中UGIB的发生率.
- 评估临床影响,并确定该患者群体中与UGIB相关的风险因素.
主要方法:
- 一个回顾性单中心研究分析了150个V-AECMO病例从2013-2017年,不包括早期死亡.
- 怀疑UGIB的患者接受了食道胃管腺镜检查 (EGD) 以诊断和与一般V-A ECMO队列进行比较.
- 从ECMO启动到移植后5天收集了数据.
主要成果:
- UGIB的发病率为10.7%,平均发病时间为10天.
- UGIB与增加的输血需求,更长的机械呼吸和VAECMO持续时间,以及延长ICU和住院时间有关.
- 胃潰瘍病史是UGIB的唯一獨立風險因素 (OR=7.32,p=0.042).
结论:
- 在V-A ECMO患者中,UGIB是常见的并发症,显著增加了医疗保健资源消耗.
- 标准的预防措施,包括质子抑制剂和肠道营养,没有证明对UGIB有保护作用.
- 需要进行进一步的研究,以建立在V-A ECMO患者中UGIB的有效预防策略.
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