儿童心肌炎的机械循环支持:在全国代表性队列中支持策略和结果
Alicia M Kamsheh1, Jonathan B Edelson2, Jennifer Faerber3
1Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, MO.
JHLT open
|July 17, 2024
概括
机械循环支持 (MCS) 越来越多地用于儿科心肌炎,体外膜氧化 (ECMO) 是最常见的. 虽然死亡率仍然很高,但在这种患者群体中,ECMO和其他MCS策略之间的结果并没有显著差异.
科学领域:
- 儿童心脏病学 儿童心脏病学
- 关键护理医学 关键护理医学
- 心血管外科心血管外科
背景情况:
- 心肌炎经常导致儿科心力衰竭,往往需要机械循环支持 (MCS).
- 了解MCS策略和儿科心肌炎的结果对于改善患者护理至关重要.
研究的目的:
- 描述在全国范围内诊断为心肌炎的儿科患者队列中使用各种MCS策略的情况.
- 为了确定MCS用于儿科心肌炎的时间趋势.
- 为了比较不同MCS策略的患者结果.
主要方法:
- 使用了儿童住院患者数据库 (KID),这是2003-2016年全国行政出院数据样本.
- 使用ICD-9/10代码识别了儿科心肌炎入院病例.
- 使用后勤回归分析比较MCS结果.
主要成果:
- 在5,661例儿科心肌炎病例中,MCS被用于7.5%的病例.
- 体外膜氧化 (ECMO) 是MCS的主要策略 (73.6%),包括体外心肺复苏 (ECPR).
- 在接受MCS的患者中,死亡率高 (28.3%),在VAD-only/combination MCS和非ECPR ECMO组之间没有观察到死亡率的显著差异.
结论:
- 机械循环支持在13例儿科心肌炎病例中约有1例使用,随着时间的推移,趋势越来越强.
- 尽管总体死亡率高,ECMO仍然是最常用的MCS模式.
- 需要进一步的前性研究来最终评估不同MCS模式在儿科心肌炎中的比较有效性.
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