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患有体外膜氧化支持患者的胸管治疗引起的出血并发症
Axel Dimberg1,2, Magnus Dalén1,2, Lars Mikael Broman3,4
1Department of Cardiothoracic Surgery, Karolinska University Hospital, 141 86, Stockholm, Sweden.
胸腔管在体外膜氧化 (ECMO) 支持期间增加出血风险,特别是当在管后插入时. 这种并发症与更长的ECMO持续时间和降低的生存率有关.
科学领域:
- 心血管医学 心血管医学
- 胸部外科手术 胸部外科手术
- 关键护理医学 关键护理医学
背景情况:
- 在接受体外膜氧化治疗 (ECMO) 的患者中,出血是常见的并发症.
- 胸管放置是非ECMO患者出血的已知风险因素,但ECMO期间的特定风险尚未确定.
研究的目的:
- 在接受ECMO的患者中确定胸管相关出血的发生率,促成因素和结果.
- 在ECMO支持之前和期间放置的胸管之间比较出血率.
主要方法:
- 一个单一中心的观察性研究包括儿科和成人患者在ECMO (2010-2024) 期间使用胸腔管治疗肺胸或胸腔液.
- 主要出血是由胸管输出,需要输血或手术干预来定义的.
- 分析了来自168名患者的279个胸腔管.
主要成果:
- 严重出血发生在12.5%的患者 (8.1%的管道).
- 在ECMO (11.3%) 和ECMO前 (4.7%) 放置管道时,出血的发生率明显高于ECMO前 (4.7%).
- 患有出血并发症的患者ECMO持续时间较长,住院存活率较低 (47.6%vs71.4%).
结论:
- 在ECMO期间插入胸管显著增加了严重出血的风险.
- 流血并发症与较差的患者结局有关,包括减少存活率.
- 胸壁是ECMO期间与胸管相关的出血最常见的地方.
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