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严重感染儿童的儿科ECMO结果:感染源是否重要?
Tiffany Zens1, Brian Lara2, Brielle Ochoa3
1Division of Pediatric Surgery, Department of Surgery, Phoenix Children's Hospital, Phoenix AZ, USA; Michigan Medical School, University of Michigan, Ann Arbor, MI, USA.
Journal of pediatric surgery
|January 29, 2025
概括
患有严重感染的儿童体外膜氧化 (ECMO) 结果因病原体而异. 阳性血液和呼吸道培养在管时显著增加儿科ECMO患者的死亡风险.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 传染性疾病 传染性疾病
- 支持心肺血管的支持.
背景情况:
- 外体膜氧化 (ECMO) 改善了由于感染引起的心肺衰竭的儿科患者的生存率.
- 然而,特定感染病因对ECMO结果的影响仍然不清楚.
- 这项研究调查了感染培养数据如何影响接受ECMO的儿童的结果.
研究的目的:
- 根据感染病因学,比较患有败血症和严重急性肺损伤的儿科患者的ECMO结果.
- 分析阳性培养数据在ECMO治疗期间和之后对死亡率的影响.
主要方法:
- 对儿童患者 (<18岁) 进行回顾性审查,这些患者在严重感染中使用ECMO治疗 (2013-2022年).
- 在ECMO注射管时分析呼吸道和血液培养数据.
- 使用单变量和多变量回归模型比较死亡率.
主要成果:
- 在ECMO中,总死亡率为36%,离院死亡率为51%.
- 管时血和呼吸道培养呈阳性的患者在ECMO上死亡风险增加了7.65倍 (p=0.004).
- 多种病毒感染 (例如RSV,COVID) 与更高的ECMO死亡率有关,而多微生物细菌性肺炎没有显著差异.
结论:
- 传染源对患有心肺衰竭的儿科患者的ECMO结果产生重大影响.
- 在启动ECMO之前,确定特定的病原体对于预后和家庭咨询至关重要.
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