Department of Surgery, University of California Irvine Medical Center, Orange, California; Division of Pediatric Surgery, Children's Hospital of Orange County, Orange, California.
Department of Surgery, University of California Irvine Medical Center, Orange, California.
J Surg Res. 2021 Jul;263:14-23. doi: 10.1016/j.jss.2021.01.007. Epub 2021 Feb 20.
Neonates receiving extracorporeal life support (ECLS) for congenital diaphragmatic hernia (CDH) require prolonged support compared with neonates with other forms of respiratory failure. Hemolysis is a complication that can be seen during ECLS and can lead to renal failure and potentially to worse outcomes. The purpose of this study was to identify risk factors for the development of hemolysis in CDH patients treated with ECLS.
The Extracorporeal Life Support Organization database was used to identify infants with CDH (2000-2015). The primary outcome was hemolysis (plasma-free hemoglobin >50 mg/dL). Potentially associated variables were identified in the data set. Descriptive statistics and a series of nested multivariable logistic regression models were used to identify associations between hemolysis and demographic, pre-ECLS, and on-ECLS factors.
There were 4576 infants with a mortality of 52.5%. The overall mean rate of hemolysis was 10.5% during the study period. In earlier years (2000-2005), the hemolysis rates were 6.3% and 52.7% for roller versus centrifugal pumps, whereas in later years (2010-2015), they were 2.9% and 26.5%, respectively. The fully adjusted model demonstrated that the use of centrifugal pumps was a strong predictor of hemolysis (odds ratio: 6.67, 95% confidence interval: 5.14-8.67). In addition, other risk factors for hemolysis included low 5-min Apgar score, on-ECLS complications (renal, metabolic, and cardiovascular), and duration of ECLS.
In our cohort of CDH patients receiving ECLS over 15 y, the use of centrifugal pumps increased over time, along with the rate of hemolysis. Patient- and treatment-level risk factors were identified contributing to the development of hemolysis.
与患有其他类型呼吸衰竭的新生儿相比，接受体外生命支持（ECLS）治疗的先天性膈疝（CDH）新生儿需要更长时间的支持。溶血是 ECLS 期间可能出现的一种并发症，可导致肾衰竭，并可能导致更差的结局。本研究的目的是确定接受 ECLS 治疗的 CDH 患者发生溶血的危险因素。
使用体外生命支持组织数据库确定 2000-2015 年间患有 CDH 的婴儿。主要结局是溶血（血浆游离血红蛋白＞50mg/dL）。在数据集内确定潜在相关变量。使用描述性统计和一系列嵌套多变量逻辑回归模型，确定溶血与人口统计学、ECLS 前和 ECLS 期间因素之间的关系。
共有 4576 例婴儿，死亡率为 52.5%。研究期间总体溶血发生率为 10.5%。在早期（2000-2005 年），滚压泵和离心泵的溶血率分别为 6.3%和 52.7%，而在后期（2010-2015 年），溶血率分别为 2.9%和 26.5%。完全调整模型表明，使用离心泵是溶血的强烈预测因素（比值比：6.67，95%置信区间：5.14-8.67）。此外，溶血的其他危险因素包括低 5 分钟 Apgar 评分、ECLS 期间的并发症（肾、代谢和心血管）以及 ECLS 持续时间。
在我们的 CDH 患者队列中，接受 ECLS 治疗超过 15 年，随着时间的推移，离心泵的使用增加，同时溶血的发生率也增加。确定了与溶血发展相关的患者和治疗水平的危险因素。
