儿科静脉动脉外体生命支持中的左心室减压:审查证据
Giacomo Veronese1,2, Paolo Meani2,3, Domenico Sirico4
1Pediatric Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.
ESC heart failure
|May 26, 2025
概括
在儿科静脉动脉外体生命支持 (VA ECLS) 期间的左心室减压是复杂的和不一致的应用. 策略因患者年龄和临床背景而异,在心脏切除术后的病例中最明显的好处.
科学领域:
- 儿童心脏病学 儿童心脏病学
- 身体外膜氧化 (ECMO) 是一种方法.
- 关键护理医学 关键护理医学
背景情况:
- 静脉动脉外体生命支持 (VA ECLS) 对新生儿和患有循环崩的儿童至关重要.
- VA ECLS可能导致左心室 (LV) 过载,阻碍心肌恢复并导致并发症.
- 在儿科VAECLS中最佳的LV减压策略尚未得到充分证实.
研究的目的:
- 系统地审查VA ECLS的儿科患者 (18岁以下) 的LV减压策略.
- 分析不同 LV 解压方法的流行率,技术,安全性和结果.
- 确定影响战略选择的因素,并突出未来研究的领域.
主要方法:
- 根据PRISMA指南 (1993-2024) 进行系统审查.
- 包括11个回顾性队列和基于注册表的研究 (2012-2024年),涉及1222名儿科患者.
- 关于VA ECLS和LV减压的13个病例系列和28个病例报告的审查.
主要成果:
- 根据临床环境 (例如,心脏切除术后) 的情况,LV减压的患病率有所不同 (10.5%至46.6%).
- 穿皮减压 (57.4%) 和气球心房隔膜造影 (50%) 是常见的,特别是在外围VA ECLS的年轻患者中.
- 在中央VA ECLS中,特别是心脏切除术后,外科手术方法占主导地位;并发症率因技术而异.
结论:
- 儿科VA ECLS期间的LV减压具有挑战性,采用了多样化和不一致的策略.
- 在心脏切除术后的环境中,益处更明显,显示出更好的生存率和减少不良事件.
- 进一步的前性研究和协作注册对于规范化策略和优化风险效益概况至关重要.
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