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婴儿体外膜氧化 (ECMO) 诱导的血液溶解的等离子酶

Gail Budhu¹, Kaydeen Morris-Whyte¹, Alexandru R Constantinescu²

¹Pediatric Residency Program, Joe DiMaggio Children's Hospital, Memorial Healthcare System, 1005 Joe DiMaggio Dr. Hollywood, FL 33021, USA.

The journal of extra-corporeal technology

|December 20, 2024

概括

治疗性血交换 (TPE) 在新生儿在体外膜氧化 (ECMO) 上有效降低了无血血红蛋白 (PFH). 这种方法虽然有希望,但强调需要ECMO诱导血解指南.

科学领域:

新生儿重症监护室新生儿重症监护室
儿科重症监护儿科重症监护
身体之外的生命支持.

背景情况:

血管内血液溶解是体外膜氧化 (ECMO) 的严重并发症,导致不良结果,如脏替代疗法和增加死亡率.
血自由血红蛋白 (PFH) 的升高是ECMO诱导血液溶解的关键指标.
目前的体外生命支持组织 (ELSO) 准则并没有专门讨论ECMO诱导的血液溶解的治疗.

研究的目的:

描述治疗性血交换 (TPE) 在治疗新生儿严重的ECMO诱导血液溶解中的使用.
评估与ECMO同时使用的TPE的疗效和耐受性.

主要方法:

两个处于静脉动脉 (VA) ECMO 的新生儿患有严重的PFH (>500 mg/dL) 被用TPE治疗.
在TPE电路中,红细胞被加密,并使用酸盐抗凝剂.
盐水溶液被用作酸盐诱,以防止低热血和内出血,用新鲜冷血 (FFP) 代替血体积.

主要成果:

在一名患者中,PPH在TPE后下降,但在稳定之前在210-300 mg/dL之间波动;该患者从ECMO中获释,但没有存活.
在第二名患者中,PFH在TPE后改善到360 mg/dL,随后下降到120 mg/dL,尽管治疗被取消了.

结论:

治疗性血交换 (TPE) 在接受ECMO的新生儿中有效降低无血血红蛋白 (PFH) 水平.
当与ECMO同时使用时,TPE似乎被很好地容忍.
需要为ECMO诱导的血液溶解的婴儿建立一个数据库,以制定最佳治疗的临床指南.

关键词:

通过ECMO诱导的血液溶解.婴儿婴儿婴儿治疗性等离子体交换 (TPE)

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