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Prevalence of hemolysis and metabolic acidosis in patients with circulatory failure supported with extracorporeal life support: a marker for survival?
体外生命支持的循环衰竭患者溶血和代谢性酸中毒的患病率: 生存的标志?
ECLS ECPR cardiogenic shock hemolysis plasma-free-hemoglobin resuscitation
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摘要

AIMS:Elevated levels of plasma free hemoglobin (fHb) indicate red blood cell (RBC) damage. The aim of this study was to analyze the prevalence of hemolysis and metabolic acidosis in patients on extracorporeal life support (ECLS) and to investigate whether it is a marker for outcome.
METHODS AND RESULTS:This retrospective analysis included 215 adult patients with cardiac failure treated with ECLS. The cohort was divided into three groups: ECLS (1) during ongoing cardiopulmonary resuscitation (CPR, n = 110); (2) after CPR with return of spontaneous circulation and sustained cardiogenic shock (n = 45); (3) in severe cardiogenic shock without previous CPR (n = 60). Lactate, arterial pH value and fHb were measured daily before (pre-fHb) and during ECLS. CPR caused a pronounced increase in pre-fHb (group1, 318 (138/586) mg/L; group2, 212 (107/439) mg/L; group3, 79 (53/232) mg/L; p < 0.001). Within 24 hours on ECLS, fHb declined significantly. Compared to group 3 without CPR, group1 and 2 had a lower pH value (group1, 7.10 (6.93/7.20); group2, 7.21 (7.16/7.27); group3, 7.28 (7.20/7.35); p < 0.001), and an increased lactate level (group1, 88 (55/129) mg/dL; group2, 76 (36/111) mg/dL; group3, 52 (25/83) mg/dL; p < 0.0001). Multivariante analysis showed that pre-fHb had no prognostic value for survival. Only a low pre-lactate was a surrogate marker for successful weaning (p < 0.0001) and discharge from hospital (p = 0.0028).
CONCLUSIONS:CPR was associated with a strongly increased fHb irrespective of ECLS. Implantation of ECLS did not aggravate hemolysis but instead decreased it within 24 hours. In this study low pre-fHb had no predictive value for survival.

译文

目的: 血浆游离血红蛋白 (fHb) 水平升高表明红细胞 (RBC) 受损。本研究的目的是分析体外生命支持 (ECLS) 患者溶血和代谢性酸中毒的患病率,并调查其是否是结局的标志。
方法和结果: 这项回顾性分析包括 215 名接受 ECLS 治疗的成年心力衰竭患者。队列被分为三组: 正在进行的心肺复苏 (CPR,n = 110) 期间的 ECLS (1); (2) 心肺复苏后,自主循环恢复,持续心源性休克 (n = 45); (3) 未进行心肺复苏的严重心源性休克 (n = 60)。在 ECLS 之前和期间每天测量乳酸、动脉 ph值和 fHb。心肺复苏术导致了前 fHb 的显著增加 (第一组,318 (138/586) 毫克/升; 第二组,212 (107/439) 毫克/升; 第三组,79 (53/232) 毫克/升; p <0.001)。在 ecl 的 24 小时内,fHb 显著下降。与没有心肺复苏术的组 3 相比,第一组和第二组的 ph值较低 (第一组,7.10 (6.93/7.20); 第二组,7.21 (7.16/7.27); 第三组, 7.28 (7.20/7.35); p <0.001),和增加的乳酸水平 (55/129 组,88 (36/111) mg/dL; 组,76 () mg/dL;第三组,52 (25/83) mg/dL; p <0.0001)。多变量分析显示 fHb 前期对生存没有预后价值。只有低预乳酸是成功断奶 (p & lt; 0.0001) 和出院 (p = 0.0028) 的替代指标。
结论: CPR 与 fHb 强烈增加相关,而与 ecl 无关。植入 ECLS 不会加重溶血,而是在 24 小时内降低溶血。在这项研究中,低前 fHb 对生存没有预测价值。

Metabolic Acidosis

内分泌 代谢性疾病 疾病
概述  :  

代谢性酸中毒是当人体产生过量的酸(例如酮酸或乳酸)时发生的疾病,肾脏无法除去正常代谢产生了的酸,或人体失去太多的碳酸氢根离子。如果不加以控制,则代谢性酸中毒可导致酸血症,从而使得动脉血的pH值低于7.37 ,其原因多种多样,后果可能很严重,包括昏迷和死亡。与呼吸性酸中毒一起,它是酸血症的两个普遍原因之一。临床表现症状不是特异的,除非患者有明确的动脉血气采样指征,否则诊断可能会很困难。症状包括心悸,头痛,精神状态改变,如严重的焦虑因缺氧,视力异常,恶心,呕吐,腹痛,食欲改变及体重增加,肌肉无力

metabolic   英 /ˌmetəˈbɒlɪk/   美 /ˌmetəˈbɑːlɪk/

释    义   adj. 变化的;新陈代谢的

同根词   metabolism n. 新陈代谢

               metabolize vi. 新陈代谢

               metabolize vt. 使新陈代谢;使变形

例    句   Building of energy and cellular metabolic substances that are needed for the body. 能量和细胞新陈代谢的皮质的建立那是身体所需要的。

 

acidosis   英 /,æsɪ'dəʊsɪs/   美 /,æsɪ'dosɪs/

释    义   n. [内科] 酸中毒,酸毒症;酸液过多症

同根词   acidotic adj. 酸中毒的;定酸量的

               acidity n. 酸度;酸性;酸过多;胃酸过多

例    句   In addition, some people think that these children snoring at night acidosis phenomenon, would lead to stagnation in the growth of children. 此外,有人认为这些睡眠打鼾小儿在夜间有酸中毒现象,会导致孩子生长停滞。

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