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Crit Care:体外膜肺氧合治疗COVID-19和H1N1流感相关急性呼吸窘迫综合征效果比较

2022-02-07 MedSci原创 MedSci原创

在接受体外膜肺氧合的ARDS患者中,研究人员观察到未经调整的60天死亡率在COVID-19患者中高于H1N1肺炎患者。多变量调整后,死亡率的差异不显著。

体外膜肺氧合已成为包括甲型H1N1流感在内的多种病因的严重急性呼吸窘迫综合征(ARDS)的既定治疗手段。在2019冠状病毒病(COVID-19)患者中接受体外膜肺氧合治疗的益处仍未明确。

近日,危重病医学领域权威杂志Critical Care上发表了一篇研究文章,这项分析的目的是比较接受静脉-静脉体外膜肺氧合治疗COVID-19和甲型H1N1流感相关ARDS的患者的结局。

这是一项多中心回顾性队列研究,纳入了2009年至2021年期间在意大利7个ICU中接受体外膜肺氧合治疗COVID-19和甲型H1N1肺炎ARDS成年患者。该研究的主要结局是体外膜肺氧合开始后60天的全因死亡率。研究人员使用多变量Cox模型来估计体外膜肺氧合开始前的患者特征和治疗因素的死亡率差异。该研究的次要结局是90天死亡率、ICU和住院时间以及体外膜肺氧合相关并发症。

该研究纳入了接受体外膜肺氧合支持治疗的308名COVID-19(N=146)和H1N1(N=162)相关ARDS患者的数据。COVID-19(46%)患者开始体外膜肺氧合治疗后60天的估计累积死亡率高于H1N1(27%)患者(风险比为1.76,95%CI为1.17-2.46)。在调整混杂因素时,特别是体外膜肺氧合支持前的年龄和住院时间,风险比降至1.39,95%CI为0.78-2.47。COVID-19患者的ICU和住院时间、体外膜肺氧合和有创机械通气的持续时间以及体外膜肺氧合相关的出血并发症高于H1N1患者。

由此可见,在接受体外膜肺氧合的ARDS患者中,研究人员观察到未经调整的60天死亡率在COVID-19患者中高于H1N1肺炎患者。多变量调整后,死亡率的差异不显著;开始体外膜肺氧合治疗之前的年龄较大和住院时间较长成为重要的协变量,可以解释观察到的死亡率差异。

原始出处:

Vito Fanelli,et al.Extracorporeal membrane oxygenation for COVID-19 and influenza H1N1 associated acute respiratory distress syndrome: a multicenter retrospective cohort study.Critical Care.2022.https://ccforum.biomedcentral.com/articles/10.1186/s13054-022-03906-4

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    2022-02-12 杨海东

    坚持学习

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    2022-02-09 TZF0806
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甲型H1N1流感疫情今年在印度卷土重来。根据印度卫生和家庭福利部公布的最新数据,今年以来印度全国共报告34009例甲型H1N1流感病例,其中1741人死亡。据《印度斯坦时报》26日援引卫生和家庭福利部的数据,甲型H1N1流感死亡人数最多的是马哈拉施特拉邦,共568人死亡;其次是古吉拉特邦,413人死亡。这两个邦的感染人数分别为5191人和6994人。数据还显示,截至目前,印度首都新德里确诊2755

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