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儿科ECMO中出血和血栓形成的时间趋势和危险因素:一个多中心队列研究
Kevin J Doré1, Carlton M Kelly2, Timothy T Cornell1
1Department of Pediatrics, Division of Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Perfusion
|July 31, 2025
概括
在儿科外体膜氧化 (ECMO) 中,出血和血栓形成是常见的,其风险随着时间的推移而变化. 以前的出血或血栓形成会影响未来的风险,这表明儿科ECMO患者需要动态抗凝策略.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 心血管研究的心血管研究.
- 血液学 血液学 血液学
背景情况:
- 流血和血栓形成是儿科外体膜氧化 (ECMO) 的重要并发症,影响患者的治疗结果.
- 在儿科ECMO中,这些事件的时间依赖性和预测因素尚未完全理解.
- 准确的风险评估对于管理抗凝药和提高生存率至关重要.
研究的目的:
- 在接受ECMO的儿科患者中评估出血和血栓事件的临床预测因素.
- 分析ECMO期间与出血和血栓形成相关的时间到事件风险.
- 确定影响这些并发症风险不断变化的因素.
主要方法:
- 从2011年到2024年使用儿科ECMO结果注册表 (PEDECOR) 进行的回顾性队列研究.
- 包括1444名儿科患者 (≤18岁) 在他们的第一个ECMO运行.
- 利用时间变化的考克斯比例危险模型来评估出血和血栓形成的风险因素.
主要成果:
- 在65%的患者中发生出血,第一次事件的中位时间为2天;血栓形成发生在28%的患者中,中位时间为3天.
- 之前的血栓形成降低了早期出血风险 (HR:0.39),但随着时间的推移,这种影响反转了 (12.4天的交叉).
- 以前的出血降低了早期血栓形成的风险 (HR:0.49),随着时间的推移而逆转 (在4.3天的交叉). 败血症与血栓形成有关;中央管,心脏手术和非肺性指示与出血有关.
结论:
- 在儿科ECMO期间,出血和血栓形成是频繁且动态的风险.
- 在ECMO过程中,先前出血/血栓形成和后续事件之间的相互作用会发生变化.
- 这些发现支持基于儿科ECMO中不断变化的患者风险概况的适应性抗凝策略的需要.
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