摘要
目的研究血制品在动脉-静脉体外膜肺氧合(veno-arterial extracorporeal membrane oxygenation,VA-ECMO)患者中的应用并探讨其对预后的影响。方法回顾性分析2017年1月至2020年6月于南京医科大学第一附属民医院急诊科行VA-ECMO治疗的成人患者共83例。分析死亡组(n=37)和存活组(n=46)患者的基线资料差异,并采用二元logistic回归分析VA-ECMO患者28 d病死率的相关危险因素,并采用ROC曲线计算阈值。结果:血小板输注量(OR=2.506,95%CI:1.142-5.499,P=0.022)、非心肌炎性疾病(OR=6.881,95%CI:1.615~29.316,P=0.009)为成人VA-ECMO患者28 d病死率的相关危险因素,血小板输注量阈值为0.427 mL/(kg·d),可预测患者ECMO上机28 d病死率,敏感度为78.4%,特异性为69.6%(曲线下面积:0.735)。结论血小板输注量的增加与成人VA-ECMO患者的不良预后相关,心肌炎患者行VA-ECMO治疗效果较好.
Objective To study the application of blood products in patients with veno-arterialextracorporeal membrane oxygenation(VA-ECMO)and evaluate its effect on the prognosis.Methods Atotal of 83 adult patients treated with VA-ECMO in the Emergency Department of the First Affiliated Hospitalof Nanjing Medical University from January 2017 to January 2020 were grouped by survival to explore the riskfactors of 28-day mortality using binary logistic regression,and the threshold was calculated by ROC curve.Results Platelet transfusion(OR=2.506,95%CF:1.142-5.499)and non-myocarditis disease(OR=6.881,95%CI:1.615-29.316)were the risk factors of 28-day mortality in adult VA-ECMO patients.The threshold of platelettransfusion was 0.427 mL/(kg·d)(sensitivity 78.4%,specificity 69.6%,AUC 0.735).Conclusions Theincreased platelet transfusion is related to the poor prognosis of adult patients with VA-ECMO.Refractorymyocarditis patients are better treated with VA-ECMO.
作者
朱轶
陈旭锋
张劲松
梅勇
吕金如
张刚
胡德亮
李伟
张华忠
孙峰
吴娟
高永霞
黄夕华
张慧
Zhu Yi;Chen Xufeng;Zhang Jinsong;Mei Yong;Lv Jinru;Zhang Gang;Hu Deliang;Li Wei;Zhang Huazhong;Sun Feng;Wu Juan;Gao Yongxia;Huang Xihua;Zhang Hui(Emergency Medicine Department,the First Affiliated Hospital of Nanjing Medical University,Nanjing,210029,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2021年第10期1177-1181,共5页
Chinese Journal of Emergency Medicine
基金
江苏省医学创新团队(CXTDA2017007)
江苏省“六大人才高峰”(2019WSN-005)
江苏省“六个一工程”拔尖人才(LGY20190688)
江苏省人民医院“511腾飞工程”(2018)。
