儿童肥胖与体外膜肺氧合：成功治疗结果的特殊考量
Childhood Obesity and Extracorporeal Membrane Oxygenation: Special Considerations for Successful Outcomes.
作者信息
Iyengar Amit, Zhu Allen, Samson Jessica, Reemtsen Brian, Biniwale Reshma
机构信息
David Geffen School of Medicine, University of California, Los Angeles, California, United States.
Department of Perfusion Services, University of California, Los Angeles, California, United States.
出版信息
J Pediatr Intensive Care. 2017 Jun;6(2):109-116. doi: 10.1055/s-0036-1584681. Epub 2016 Jun 24.
The effects of obesity on venoarterial extracorporeal membrane oxygenation (VA-ECMO) outcomes in pediatric population are unknown. We performed retrospective analysis of 41 children (age 2-18 years) undergoing VA-ECMO. The percentage difference between actual body weight and lean body weight, referred to as Δmass, was calculated. Ratios of Δmass to ECMO flow were calculated at 4 and 24 hours. In patients with Δmass:flow ≥ 0.1 at 4 hours, higher 24-hour lactates (20.0 vs. 14.5 mg/dL; = 0.002) and inotrope scores (17.3 vs. 11.2; = 0.015) were observed. However, elevated Δmass:flow was not associated with mortality, and in-hospital mortality rates between groups were similar (53 vs. 45%; = 0.647). In obese pediatric patients requiring VA-ECMO, increased flow is necessary to avoid complications of hypoperfusion and related complications.
肥胖对儿童静脉-动脉体外膜肺氧合（VA-ECMO）治疗结果的影响尚不清楚。我们对41例接受VA-ECMO治疗的2至18岁儿童进行了回顾性分析。计算实际体重与瘦体重之间的百分比差异，称为Δmass。计算4小时和24小时时Δmass与ECMO流量的比值。在4小时时Δmass:流量≥0.1的患者中，观察到24小时乳酸水平较高（20.0对14.5mg/dL；P = 0.002）和血管活性药物评分较高（17.3对11.2；P = 0.015）。然而，Δmass:流量升高与死亡率无关，两组间的住院死亡率相似（53%对45%；P = 0.647）。在需要VA-ECMO的肥胖儿科患者中，需要增加流量以避免低灌注并发症及相关并发症。
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