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在接受家庭亲肠道营养的儿童中预防性抗凝剂:国际前性多中心研究
Aysenur Demirok1, Sjoerd C J Nagelkerke1, Samantha C Gouw2
1Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers University of Amsterdam, Amsterdam, the Netherlands.
Clinical nutrition (Edinburgh, Scotland)
|February 1, 2025
概括
预防性抗凝剂并没有显著降低接受家庭亲肠道营养 (HPN) 的儿童的导管相关血栓形成 (CRT). 最佳的导管护理和感染预防至关重要,因为与导管相关的血液感染 (CRBSI) 在CRT患者中更常见.
科学领域:
- 儿科胃肠病学 儿科胃肠病学
- 血液学 血液学 血液学
- 临床营养学 临床营养学
背景情况:
- 导管相关的血栓形成 (CRT) 是儿童需要家庭亲肠营养 (HPN) 由于慢性肠衰竭 (CIF) 的显著风险.
- 目前的儿科HPN指南表明,没有足够的证据来支持常规预防性使用抗凝血剂来预防CRT.
研究的目的:
- 评估预防性抗凝剂在预防HPN儿科患者中CRT的疗效和安全性.
- 评估预防性抗凝剂与该人群中CRT发病率之间的关联.
主要方法:
- 一项前性,国际,多中心研究,涉及儿童 (0-18岁) 在HPN.
- 患者被分为预防和非预防组,随后进行24个月的CRT年度超声波查.
- 使用倾向分数分层和逻辑回归来分析预防性抗凝剂和CRT之间的关联,并对共变量进行调整.
主要成果:
- 整体CRT发生率为0.17每1000个导管日,在预防 (11%) 和非预防 (11%) 组之间没有统计学上显著的差异 (OR 0.64,p=0.60).
- 导管相关的血流感染 (CRBSI) 的发病率为每1000个导管日0.34 (n=25).
- 与没有CRT (14%) (p=0.010) 的患者相比,CRT患者的CRBSI发病率显著更高 (54%). 在预防组中发生了两次轻微出血事件.
结论:
- 预防性抗凝药似乎不能显著降低儿童HPN患者的CRT发病率.
- 这些发现强调了细致的导管护理和感染控制的重要性,因为CRT和CRBSI之间存在关联.
- 需要进行更大的多中心试验,以建立基于证据的指导方针,用于儿童HPN的预防性抗凝药.
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