未经证实:由微血管灌注不良引起的急性肢体缺血可能是初始治疗的难治性。药物水蛭疗法(水蛭疗法)已尝试在整形和重建手术中改善缺血皮瓣的静脉充血;然而,与动脉灌注不良继发的缺血相关的报道很少。我们评估了来自学术重症监护病房的难治性肢体缺血的儿科队列,其中尝试了hirudo疗法以阐明其用途和结果。
UNASSIGNED:查询机构患者数据库以确定在儿科重症监护病房接受hirudo治疗并符合纳入/排除标准的儿科患者(<18岁)。评估患者图表的指标,包括人口统计学,原发疾病,凝血状态,血管通路,血管活性药物剂量,出血,水蛭的使用,肢体和死亡率结果。评估数据以确定趋势或对结果的可疑影响。
UNASSIGNED:在7例肢体缺血患者中使用了Hirudo疗法,5患有先天性心脏病,和另外两个患有病毒性休克。识别缺血后施用水蛭的时间平均为3天,使用时间平均3.9天。5例患者因出血停止治疗。死亡率为57%,都是继发于多器官衰竭。在3名幸存的患者中,5个治疗肢体中的4个导致最小部分截肢。在使用水蛭之前,血管活性-正性肌力评分趋于较高,提示动脉灌注不良的血管收缩途径。没有出现与挽救肢体或不良反应相关的可识别趋势。失血量随着水蛭的应用而增加,总输血需求也是如此。
UNASSIGNED:该病例系列建立了在由动脉灌注不良引起的急性肢体缺血的危重患儿中使用hirudo疗法的基线数据。根据这个回顾性队列,对于儿科重症监护病房中动脉灌注不良引起的急性肢体缺血,我们不推荐常规使用hirudo疗法.leeches的应用应与定义开始和停止参数的协议保持一致,水蛭标准化利用,并监测不良结果。未来的研究将受益于研究结果的共识定义,包括灌注恢复,组织/肢体抢救和出血表现。在使用任何标准或系统建议之前,需要进行其他前瞻性研究。
UNASSIGNED: Acute limb ischemia due to microvascular malperfusion may be refractory to initial therapies. Medicinal leech therapy (
hirudotherapy) has been attempted in plastic and reconstructive surgery to improve venous congestion in ischemic flaps; however, there are minimal reports related to ischemia secondary to arterial malperfusion. We evaluated a pediatric cohort from an academic intensive care unit with refractory limb ischemia in whom hirudotherapy was attempted to elucidate its use and outcomes.
UNASSIGNED: Institutional patient database was queried to identify pediatric patients (<18 years) who received
hirudotherapy in the pediatric critical care unit and met inclusion/exclusion criteria. Patient charts were evaluated for indices including demographics, primary disease, coagulative status, vascular access, vasoactive medication dosing, bleeding, leech use, limb and mortality outcomes. Data was evaluated to identify trends or suspected impact on outcomes.
UNASSIGNED: Hirudotherapy was used in 7 patients for limb ischemia, 5 with congenital heart disease, and 2 others with viremic shock. Time to leech application following recognition of ischemia averaged 3 days, with duration of use averaging 3.9 days. Five patients discontinued therapy due to bleeding. Mortality rate was 57%, all secondary to multiorgan failure. In 3 surviving patients, 4 of 5 treated limbs resulted in at minimum partial amputation. Vasoactive-inotropic score tended higher prior to leech application, suggesting a vasoconstrictive pathway for arterial malperfusion. No identifiable trends appeared associated with salvaged limb or adverse effects. Blood loss predictably increased with leech application, as did total transfusion requirement.
UNASSIGNED: This case series establishes baseline data for use of
hirudotherapy in critically ill children with acute limb ischemia caused by arterial malperfusion. Based on this retrospective cohort, we cannot recommend routine use of
hirudotherapy for acute limb ischemia from arterial malperfusion in the pediatric intensive care unit. Application of leeches should be aligned with a protocol defining start and stop parameters, standardized leech utilization, and monitoring for adverse outcomes. Future study would benefit from consensus definitions of study outcomes, including perfusion recovery, tissue/limb salvage and bleeding manifestations. Additional prospective studies are needed prior to any standard or systematic recommendations for use.