Outcome of pediatric patients treated with extracorporeal life support after cardiac surgery
Outcome of pediatric patients treated with extracorporeal life support after cardiac surgery
复制标题
DOI：
10.1016/s0003-4975(03)00898-1
复制
发表时间：
2003-11-01
影响因子：
4.6
通讯作者：
Kulik, TJ
中科院分区：
文献类型：
--
作者：
Kolovos, NS;Bratton, SL;Kulik, TJ
背景。体外生命支持（ECLS）已经在心脏手术后的特定患者中使用了二十多年。我们之前描述了与该人群死亡相关的因素。我们现在回顾我们最近的经验来重新评估与死亡率相关的因素。在1995年7月至2001年6月期间，所有在术后7天内接受ECLS支持的儿童患者被检查以描述与生存相关的临床特征。我们将结果与之前的报告进行比较，以评估实践和结果的变化。74名患者接受了随访。50%存活到退役。住院生存率与患者年龄、插管部位或适应症无显著相关性。35%的患者在接受ECLS治疗时需要血液过滤，生存率明显较低（23%对65%）。一项多因素分析结合了我们先前报告的所有儿童和本队列显示，接受血液滤过的患者死亡的可能性是接受血液滤过的患者的5倍（优势比5.01,95%置信区间2.11-11.88）。在调整患者年龄、研究时间和术后开始ECLS前的时间后，双心室修复足够的儿童死亡风险较低（优势比0.42,95%可信区间0.19-0.91）。双心室修复足够的患者有明显更高的住院生存率，而单心室生理或需要透析的患者生存率降低。(C) 2003年由胸外科学会出版。
Background. Extracorporeal life support (ECLS) has been used for over two decades in select patients after cardiac surgery. We previously described factors associated with death in this population. We now review our recent experience to reassess factors related to mortality.Methods. All pediatric patients who received ECLS support within 7 days after surgery between July 1995 and June 2001 were examined to describe clinical features associated with survival. We compared the results with our prior report to assess changes in practice and outcome.Results. Seventy-four patients were followed. Fifty percent survived to discharge. Hospital survival was not significantly related to patient age, cannulation site, or indication. Thirty-five percent of patients required hemofiltration while on ECLS and were significantly less likely to survive (23% vs 65%). A multivariate analysis combining all children from our prior report with the present cohort revealed that patients who received hemofiltration were five times more likely to die (odds ratio 5.01, 95% confidence interval 2.11-11.88). Children with an adequate two-ventricular repair had lower risk of death (odds ratio 0.42, 95% confidence interval 0.19-0.91) after adjusting for patient age, study period, and hours elapsed before initiation of ECLS after surgery.Conclusions. Patients with an adequate two-ventricle repair have significantly higher hospital survival, whereas those with single ventricle physiology or need for dialysis have decreased survival. (C) 2003 by The Society of Thoracic Surgeons.