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在接受体外膜氧化治疗的患者中,白血球反应的病因学
Christian B Wells1, Michal J Sobieszczyk1, Joseph E Marcus1,2
1Department of Medicine, Brooke Army Medical Center, JBSA-Fort Sam Houston, TX 78234, USA.
Military medicine
|September 27, 2024
概括
在接受体外膜氧化 (ECMO) 治疗的患者中,白血病反应并不常见. 这些高白细胞计数很少表明新的感染,这表明经验性抗生素在ECMO患者的使用有限.
科学领域:
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
- 血液学 血液学 血液学
背景情况:
- 鼻腔感染是需要体外膜氧化 (ECMO) 的患者的一个重大问题.
- 白血病反应 (WBC>50,000/μL) 与某些患者群体的感染有关.
- ECMO电路激活炎症,可能降低新感染的白血病反应的特异性.
研究的目的:
- 调查成年ECMO患者中白血病反应的发生率和原因.
- 确定该群体中白血病反应和新感染之间的关联.
- 评估白血球反应在指导ECMO患者抗微生物治疗中的有用性.
主要方法:
- 从2018年到2022年对成年ECMO患者 (≥72小时) 的回顾性队列研究.
- 对患有白血球反应的患者的最大白血细胞 (WBC) 数量和临床数据的分析.
- 在白血病反应时审查感染性评估,并发病症和治疗方法.
主要成果:
- 在182名ECMO患者中,15名 (8%) 患有白血病反应 (WBC中位数为53.94 /μL).
- 大多数白血病反应是多因素的,与已知的感染 (73%),新血栓 (40%) 或使用葡萄糖皮质激素 (27%) 相关.
- 只有一个患者 (7%) 在他们的白血病反应期间被诊断出患有新感染 (Acinetobacter baumannii bacteremia).
结论:
- 在ECMO患者中,白血病反应是罕见的和多因素的.
- 在这个队列中,白血病反应对新感染的特异性较低.
- 这些发现表明,仅基于ECMO患者的白血病反应来启动或扩大抗生素的效用有限.
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