血造细胞移植后儿童的液体过载:综合性审查
Lama Elbahlawan1, Amr Qudeimat2, Ray Morrison1
1Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
Journal of clinical medicine
|November 9, 2024
概括
血造细胞移植 (HCT) 后的儿童常见的流体过载,增加了死亡风险. 早期检测和管理液体过载对于改善这些重症儿童的生存率至关重要.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 血液学 / 瘤学
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 流体过载 (FO) 是严重疾病儿童的发病率和死亡率的重要风险因素,特别是那些接受血液细胞移植 (HCT) 的儿童.
- 在HCT后的儿童面临由于必要的医疗治疗和并发症,如鼻腔阻塞综合征,移植综合征,败血症和急性损伤 (AKI) 等并发症的高流体积累风险.
- 超过10%的液体过载影响了近一半的儿科HCT患者,与儿童重症监护室 (PICU) 存活率降低和AKI恶化相关.
研究的目的:
- 突出流体过载对HCT后儿童结果的关键影响.
- 强调早期检测,预防和干预策略的必要性,以应对这种脆弱人群的流体过载.
- 讨论当前对儿科HCT患者流体过载的管理方法.
主要方法:
- 现有文献和临床数据的审查,涉及儿科HCT接受者的流体过载.
- 分析液体过载,并发症 (如AKI,呼吸衰竭) 和死亡率之间的关联.
- 评估诊断工具 (痛指数,尿路生物标志物如NGAL) 用于风险识别.
- 管理策略的评估,包括液体限制,利尿剂和持续置换疗法 (CKRT).
主要成果:
- 流体过载 (>10%) 在大约50%的儿科高血压治疗患者中发生,与PICU存活率降低有关.
- 在患有急性呼吸衰竭的儿童中,在HCT后的第3天,累积液体平衡每增加1%,就会使PICU死亡率增加3%.
- 过多的液体会加剧急性损伤,这强调了监测的重要性.
结论:
- 流体过载是儿科HCT患者不良结果的主要决定因素.
- 使用诸如痛指数和尿路生物标志物之类的工具可以帮助识别患有AKI和FO风险的个体.
- 迅速和有效的管理,包括液体限制,利尿剂和CKRT如有指示,对于改善生存和减轻并发症至关重要.
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