Cardiac Critical Care Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK.
Pediatr Crit Care Med. 2012 Sep;13(5):535-41. doi: 10.1097/PCC.0b013e318241793d.
To evaluate whether intravenous immunoglobulin was linked to a reduction in sepsis in patients with prolonged chylothoraces postpediatric cardiothoracic surgery.
Retrospective observational cohort study.
Tertiary pediatric cardiac surgical center.
Children with chylothoraces postcardiothoracic surgery from 1998 to 2006 divided into two groups: with and without intravenous immunoglobulin supplementation.
Intravenous immunoglobulin supplementation.
Thirty-seven with chylothoraces (median duration 14 days; interquartile range, 10-32 and median maximum chyle drainage 1.9 mL/kg/hr; interquartile range, 1-3) were included, and 16 (43%) received intravenous immunoglobulin. The degree of lymphopenia was worse with longer duration of chylothorax (p = .005). There was a trend toward immunoglobulin depletion-IgG (p = .07) and IgM (p = .07) with higher volume chyle loss. Twenty-two of 37 (59%) developed bloodstream infection and 24 of 37 (65%) developed sepsis related to other organ systems. The rate of bloodstream infection and of sepsis in other organ systems was high at 25 (95% confidence interval 17-39) and 23 (95% confidence interval 15-34) episodes per 1,000 intensive care unit days, respectively. Intravenous immunoglobulin was not related to the bloodstream infection rate: adjusted hazard ratio 0.88 (95% confidence interval 0.20-3.94; p = .87) or rate of sepsis in other organ systems: hazard ratio 2.31 (95% confidence interval 0.21-24.29; p = .49) or the proportion surviving to hospital discharge (p = .37).
Patients with prolonged, large-volume chyle loss had greater secondary immunodeficiency. Although the sample size was small and therefore able to detect only a large treatment effect from intravenous immunoglobulin, infectious outcomes were equal between the two groups.
评估静脉注射免疫球蛋白是否可降低小儿心胸外科术后并发长时间乳糜胸患者的脓毒症发生率。
回顾性观察性队列研究。
三级儿科心脏外科中心。
1998 年至 2006 年接受心胸外科手术后发生乳糜胸的患儿，分为两组：使用静脉注射免疫球蛋白组和未使用静脉注射免疫球蛋白组。
静脉注射免疫球蛋白。
纳入 37 例乳糜胸患儿（中位持续时间 14 天，四分位距 10-32 天；中位最大乳糜引流量 1.9 毫升/千克/小时，四分位距 1-3 毫升/千克/小时），其中 16 例（43%）接受了静脉免疫球蛋白。乳糜胸持续时间越长，淋巴细胞减少程度越严重（p =.005）。随着乳糜丢失量的增加，免疫球蛋白消耗-IgG（p =.07）和 IgM（p =.07）也呈趋势性变化。37 例中有 22 例（59%）发生菌血症，37 例中有 24 例（65%）发生与其他器官系统相关的脓毒症。菌血症和其他器官系统感染的发生率分别为 25 例（95%可信区间 17-39 例）和 23 例（95%可信区间 15-34 例）/1000 例 ICU 天，发生率较高。静脉免疫球蛋白与菌血症发生率无关：调整后的危险比为 0.88（95%可信区间 0.20-3.94；p =.87）或其他器官系统脓毒症发生率的危险比为 2.31（95%可信区间 0.21-24.29；p =.49），或存活至出院的比例（p =.37）无差异。
长时间、大量乳糜丢失的患者继发免疫缺陷更严重。尽管样本量较小，因此只能检测到静脉免疫球蛋白的大治疗效果，但两组的感染结果是相等的。
