The natural history of direct hyperbilirubinemia associated with extracorporeal membrane oxygenation.
The natural history of direct hyperbilirubinemia associated with extracorporeal membrane oxygenation.
复制标题
与体外膜氧合相关的直接高胆红素血症的自然史。
DOI：
10.1001/archpedi.1992.02160220062023
复制
发表时间：
1992
影响因子：
--
通讯作者：
E. Stork
中科院分区：
文献类型：
--
作者：
M. Walsh;D. J. Cornell;E. Stork
目的
确定接受体外膜肺氧合治疗的新生儿中直接高胆红素血症的发生率和自然史。
设计
一系列前瞻性患者。
设置
俄亥俄州的一个3级新生儿重症监护室和体外膜肺氧合中心。
参与者
连续67例患者在33个月内接受体外膜肺氧合治疗。
干预
没有。
测量/结果
26例（39%）发生直接高胆红素血症。在14例（54%）中，胆红素水平轻度升高，仅发生在体外膜肺氧合治疗期间。其余12名患者的水平升高更严重（46 +/- 10 mumol/L [2.7 +/- 0.6 mg/dL] vs 159 +/- 101 mumol/L [9.3 +/- 5.9 mg/dL]，P <0.0001）。高胆红素血症的持续时间和严重程度相关。体外膜肺氧合治疗后9周，所有患者的高胆红素血症均消退。未发现结构异常或感染原。对40例患者的铝水平进行了评估，结果显示铝水平不在毒性范围内，且与高胆红素血症无关。多元线性回归分析表明，这些病例中的高胆红素血症是由损伤的相互作用引起的，主要原因是体外膜肺氧合过程中的溶血。
结论
直接高胆红素血症经常发生在接受体外膜肺氧合治疗的患者中，可能很严重。然而，直接高胆红素血症通常会消退而无短期后遗症。溶血可能是一个重要的影响因素。
OBJECTIVE
To determine the incidence and natural history of direct hyperbilirubinemia in neonates treated with extracorporeal membrane oxygenation.
DESIGN
A prospective series of patients.
SETTING
A level 3 neonatal intensive care unit and center for extracorporeal membrane oxygenation in Ohio.
PARTICIPANTS
Sixty-seven consecutive patients treated with extracorporeal membrane oxygenation in 33 months.
INTERVENTION
None.
MEASUREMENTS/RESULTS
Twenty-six (39%) developed direct hyperbilirubinemia. In 14 (54%), bilirubin levels were mildly elevated and occurred only during extracorporeal membrane oxygenation therapy. Levels were more severely elevated in the remaining 12 patients (46 +/- 10 mumol/L [2.7 +/- 0.6 mg/dL] vs 159 +/- 101 mumol/L [9.3 +/- 5.9 mg/dL], P less than .0001). Duration and severity of hyperbilirubinemia were correlated. Hyperbilirubinemia resolved in all patients by 9 weeks after extracorporeal membrane oxygenation therapy. No structural abnormalities or infectious agents were identified as causes. Aluminum levels were evaluated for 40 patients, were not in the toxic range, and did not correlate with hyperbilirubinemia. Multiple linear regression analysis suggested that hyperbilirubinemia in these cases resulted from interaction of injuries, with the primary contributor being hemolysis during extracorporeal membrane oxygenation.
CONCLUSIONS
Direct hyperbilirubinemia occurs frequently in patients treated with extracorporeal membrane oxygenation and may be severe. However, direct hyperbilirubinemia typically resolves without short-term sequelae. Hemolysis may be an important contributing factor.
新生儿呼吸衰竭的体外循环：一项前瞻性随机研究。
影响因子：
8
作者：
Bartlett,RH;Roloff,DW;Cornell,RG;Andrews,AF;Dillon,PW;Zwischenberger,JB
通讯作者：
Zwischenberger,JB