儿童重症血液学瘤学外体生命支持的转诊途径:标准化评估和转移可以改善生存率
Hitesh S Sandhu1, Kimberly Fan2, Samir Shah1
1From the Division of Pediatric Critical Care, Department of Pediatrics, University of Tennessee Health Sciences Center, Le Bonheur Children's Hospital, Memphis, Tennessee.
实施关键血液瘤转诊途径 (CHORPE) 改善了需要ECLS的儿科患者的生存率. 这种标准化的方法改善了患者的治疗结果,并减少了转移期间的并发症.
科学领域:
- 儿童重症监护医疗
- 血液学-瘤学
- 身体外生命支持
背景情况:
- 在血液/瘤患者中,体外生命支持 (ECLS) 的使用正在增加.
- 在该群体中,ECLS的结果稳步改善.
- 需要标准化的评估和转移协议.
研究的目的:
- 开发和评估外体生命支持的临床血液瘤转诊途径 (CHORPE).
- 标准化ECLS候选人的早期评估和识别.
- 评估CHORPE对患者结果和转移并发症的影响.
主要方法:
- 为ECLS评估转移的患者的回顾性图表审查.
- 在CHORPE之前和之后的实施小组之间的结果比较.
- 分析ECLS的位置,生存率和转移并发症.
主要成果:
- 在CHORPE后的组显示显著改善了脱管的存活率 (OR=24, p=0. 01) 和出院率 (OR=15. 9, p=0. 03).
- 在CHORPE后组中,转移期间的并发症较少 (p=0. 0228).
- 临床改善导致使用后需要ECLS的患者减少 (p=0. 0120).
结论:
- 标准化的ECLS候选评价方法提高了生存率.
- 早期识别和安全转移与持续护理至关重要.
- 对于患有ECLS的儿童血液瘤患者来说,CHORPE的实施与更好的结果有关.
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