目的:手动换血(MBE)是一种治疗博德特氏菌属白细胞增多的白细胞减少疗法。
背景:我们描述了BE对恶性百日咳危重患儿临床和生物学参数的影响。
方法:这是对MBE治疗的恶性百日咳感染患者的单中心回顾性研究。它描述了血液动力学的演变,换气,MBE前后的血液学和代谢特征。
结果:在2006年1月至2021年12月之间,有9名患者(中位年龄43天,范围:13-80天)对恶性百日咳有16MBE。所有患者均机械通气,7/9患者在儿科重症监护病房(PICU)住院期间出现肺动脉高压.总的来说,3/9患者存活,平均PICU住院时间为8.5天(范围:1-52天)。我们发现白细胞计数显着降低(MBE前:61.8G/L[四分位数间距(IQR):55.8-74.8]与MBE后:19.4G/L[IQR:17.7-24.1];p≤0.001)和显着的氧合改善(MBE前SpO2/FiO2:190[IQR:106-200]vs.MBE后SpO2/FiO2:242[IQR:149-250];p=0.03)。主要副作用是血小板的显着减少(MBE前:411G/L[IQR:166.5-563.5]vs.MBE后:66G/L[IQR:46-82.5];p=<0.001)和离子钙(iCa)(MBE前iCa:1.3[IQR:1.22-1.37]vs.MBE后iCa:1.25[IQR:1.85-2.24];p=0.03)。
结论:MBE可有效减少婴儿重度百日咳博德特氏菌感染的白细胞并改善氧合。仔细监测钙和血小板似乎是强制性的。
OBJECTIVE: Manual blood exchange (MBE) is a leukoreduction therapy for hyperleukocytosis in Bordetella spp.
BACKGROUND: We describe the impact of BE on clinical and biological parameters in critically ill children with malignant pertussis.
METHODS: This is a monocentric retrospective review of patients with malignant pertussis infection treated with MBE. It describes the evolution of haemodynamic, ventilatory, haematologic and metabolic characteristics before and after MBE.
RESULTS: Between January 2006 and December 2021, nine patients (median age 43 days, range: 13-80 days) had 16 MBE for malignant pertussis. All patients were mechanically ventilated, and 7/9 patients developed pulmonary hypertension during their paediatric intensive care unit (PICU) stay. Overall, 3/9 patients survived, and the mean PICU length of stay was 8.5 days (range: 1-52 days). We found a significant reduction of the leukocyte count (pre-MBE: 61.8 G/L [interquartile range (IQR): 55.8-74.8] vs. post-MBE: 19.4 G/L [IQR: 17.7-24.1]; p ≤ 0.001) and significant oxygenation improvement (pre-MBE SpO2/FiO2: 190 [IQR: 106-200] vs. post-MBE SpO2/FiO2: 242 [IQR: 149-250]; p = 0.03). The main side effects were a significant reduction of thrombocytes (pre-MBE: 411 G/L [IQR: 166.5-563.5] vs. post-MBE: 66 G/L [IQR: 46-82.5]; p = <0.001) and of ionized calcium (iCa) (pre-MBE iCa: 1.3 [IQR: 1.22-1.37] vs. post-MBE iCa: 1.25 [IQR: 1.85-2.24]; p = 0.03).
CONCLUSIONS: MBE efficiently reduces leukocytes and improves oxygenation in severe Bordetella pertussis infection in infants. Careful monitoring of calcium and thrombocytes seems mandatory.