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在儿科外体膜氧化中抗凝管理的协议:一个比较的回顾性研究
Mirte L Jansen1, Nina C Boom2, Nienke Schalij2
1Pediatric Intensive Care Unit, Department of Intensive Care, Leiden University Hospital, Leiden, The Netherlands.
Perfusion
|January 21, 2026
概括
在儿科外体膜氧化 (ECMO) 中使用激活凝血时间,激活部分血栓形成时间或抗Xa测试监测未分离的氨酸并没有影响出血或生存. 抗Xa组显示较短的ECMO持续时间和住院时间.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 心血管外科心血管外科
- 药理学 药理学是指药理学的学科.
背景情况:
- 对于接受体外膜氧化治疗 (ECMO) 的儿童来说,抗凝药非常重要,以预防血栓形成.
- 目前用于监测未分离肝素 (UFH) 的实验室测试存在局限性,需要研究最佳方法.
- 监测测试的选择可以影响UFH剂量和患者的结果.
研究的目的:
- 根据使用的UFH监测方法,比较儿科ECMO患者中出血并发症的发生率.
- 评估二次结果,包括血栓事件,神经并发症和生存率.
- 评估不同UFH监测策略对ECMO持续时间和住院时间的影响.
主要方法:
- 一项回顾性队列研究分析了从2010年至2021年期间运行的118个儿科ECMO.
- 根据UFH监测试验,患者被分为三组:激活凝血时间 (ACT),激活部分血栓形成时间 (aPTT) 和抗Xa.
- 评估结果包括出血和血栓并发症,神经事件,存活率,ECMO持续时间和住院时间.
主要成果:
- 在各组之间没有观察到出血并发症 (46.7%ACT对比52.5%aPTT对比60.4%anti-Xa; p=0.48) 的显著差异.
- 血栓并发症,神经并发症和30天生存率在监测组之间没有显著差异.
- 抗Xa引导组经历了更短的ECMO持续时间和住院时间,接受了更高的UFH剂量,并且ECMO和住院时间最短 (p=0.02).
结论:
- 在儿科ECMO患者中,UFH监测测试 (ACT,aPTT,anti-Xa) 的选择与出血并发症或死亡率的差异无关.
- 抗Xa测定指导了更高的UFH剂量,并与减少ECMO和住院时间相关.
- 需要进一步的研究,以确定组合测试策略是否在儿科ECMO中提供更优质的抗凝管理.
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