Gbadegesin Rasheed, Zhao Shuang, Charpie John, Brophy Patrick D, Smoyer William E, Lin Jen-Jar
Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
Pediatr Nephrol. 2009 Mar;24(3):589-95. doi: 10.1007/s00467-008-1047-z. Epub 2008 Nov 12.
Hemolysis is common during extracorporeal life support (ECLS). Elevated levels of circulating plasma free hemoglobin (FHb) has been linked to the development of hemoglobinuria nephropathy. Its clinical significance in patients receiving ECLS remains unknown. Medical records of 104 children <3 years old who required ECLS after repair of congenital heart disease were reviewed. Forty-two patients required continuous renal replacement therapy (CRRT) during ECLS (CRRT group), and 62 patients did not (no-CRRT group). For all patients, FHb level and the degree of fluid overload at the end of ECLS predicted the mortality rate during ECLS. Compared with the no-CRRT group, the CRRT group had a higher mortality rate during ECLS, a higher peak FHb level during ECLS, a higher FHb level at the end of ECLS, and more days of ECLS. In the CRRT group, the FHb level at the end of ECLS predicted death during ECLS. In the no-CRRT group, the peak FHb level was associated with a worse renal function. In conclusion, elevated FHb levels were associated with renal dysfunction and death during ECLS in children undergoing cardiac surgery. Further studies are needed to elucidate the cause-effect relationship in our findings.
体外生命支持（ECLS）期间溶血很常见。循环血浆游离血红蛋白（FHb）水平升高与血红蛋白尿性肾病的发生有关。其在接受ECLS治疗的患者中的临床意义尚不清楚。回顾了104例3岁以下先天性心脏病修复术后需要ECLS的儿童的病历。42例患者在ECLS期间需要持续肾脏替代治疗（CRRT组），62例患者不需要（非CRRT组）。对于所有患者，ECLS结束时的FHb水平和液体超负荷程度可预测ECLS期间的死亡率。与非CRRT组相比，CRRT组在ECLS期间死亡率更高，ECLS期间FHb峰值水平更高，ECLS结束时FHb水平更高，且ECLS天数更多。在CRRT组中，ECLS结束时的FHb水平可预测ECLS期间的死亡。在非CRRT组中，FHb峰值水平与肾功能较差有关。总之，在接受心脏手术的儿童中，ECLS期间FHb水平升高与肾功能障碍和死亡有关。需要进一步研究以阐明我们研究结果中的因果关系。
