Risk factors for intracranial hemorrhage in adults on extracorporeal membrane oxygenation
Risk factors for intracranial hemorrhage in adults on extracorporeal membrane oxygenation
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DOI：
10.1016/s1010-7940(99)00061-5
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发表时间：
1999-04-01
影响因子：
3.4
通讯作者：
McCarthy, PM
中科院分区：
文献类型：
--
作者：
Kasirajan, V;Smedira, NG;McCarthy, PM
客观的。颅内出血是使用体外膜氧合器支持的新生儿和婴儿的一种公认的并发症，并且已经确定了与此相关的各种危险因素。与体外膜肺氧合器支持的成人颅内出血相关的患病率和危险因素尚不清楚，本研究旨在明确这些因素。方法。对 1992 年 1 月至 1996 年 12 月期间在同一机构接受体外膜氧合器支持的成年人进行了一项回顾性研究。分析年龄、性别、体重、体表面积、肾功能、抗凝、凝血变量、血液、动脉压、动脉插管部位、支持时间、颅外出血、原生心功能和颅内微栓子的存在，以确定颅内出血的危险因素。结果。在接受体外膜肺氧合器支持的 74 名成人中，有 14 名出现颅内出血（18.9%）。颅内出血风险增加与女性性别（P = 0.02，优势比 6.5）、肝素使用（P = 0.05，优势比 8.5）、肌酐大于 2.6 mg/dl（P = 0.009，优势比 6.5）、需要透析（P = 0.03，优势比 4.3）和血小板减少症（P = 0.007，比值比 18.3）。肾功能的下降和透析的需要与支持持续时间的增加有关。多变量逻辑回归显示女性性别和血小板减少症，尤其是血小板计数低于 50 000 个细胞/mm(3) 是颅内出血最重要的预测因素。颅内出血与 92.3% 的死亡率相关，而无颅内出血的死亡率为 61%（P = 0.027）。结论。颅内出血是使用体外膜氧合器支持的成人的一个重要并发症。明智的抗凝治疗、预防肾功能衰竭和积极纠正血小板减少症可能有助于降低接受体外膜肺氧合器支持的成人颅内出血的风险。 (C) 1999 Elsevier Science B.V，保留所有权利。
Objective. Intracranial hemorrhage is a recognized complication in neonates and infants on extracorporeal membrane oxygenator support and various risk factors associated with this have been defined. The prevalence and risk factors associated with intracranial hemorrhage in adults on extracorporeal membrane oxygenator support are unknown and this study was performed to define these factors. Methods. A retrospective study of adults supported with extracorporeal membrane oxygenators at a single institution between January 1992 and December 1996 was performed. Age, gender, weight, body surface area, renal function, anticoagulation, coagulation variables, blood Raw, arterial pressure, arterial cannulation sites, duration of support, extracranial bleeding, native cardiac function and presence of intracranial microemboli were analyzed to determine the risk factors for intracranial hemorrhage. Results. Fourteen out of 74 adults on extracorporeal membrane oxygenator support had intracranial hemorrhage (18.9%). An increased risk of intracranial hemorrhage showed a positive correlation with female gender (P = 0.02, odds ratio 6.5), use of heparin (P = 0.05, odds ratio 8.5), creatinine greater than 2.6 mg/ dl (P = 0.009, odds ratio 6.5), need For dialysis (P = 0.03, odds ratio 4.3) and thrombocytopenia (P = 0.007, odds ratio 18.3). Diminishing renal function and the need for dialysis were associated with increasing duration of support. Multivariable logistic regression showed female gender and thrombocytopenia, especially with platelet counts less than 50 000 cells/mm(3) to be the most important predictors of intracranial hemorrhage. Intracranial hemorrhage was associated with a mortality of 92.3% compared with a mortality of 61% in those without intracranial hemorrhage (P = 0.027). Conclusion. Intracranial hemorrhage is a significant complication in adults on extracorporeal membrane oxygenator support. Judicious management of anticoagulation, prevention of renal failure and aggressive correction of thrombocytopenia may help to lower the risk of intracranial hemorrhage in adults on extracorporeal membrane oxygenator support. (C) 1999 Elsevier Science B.V, All rights reserved.