摘要
目的:分析重症肺炎患者的病例资料,探讨静脉-静脉体外膜肺氧合(VV-ECMO)治疗的影响因素。方法:采用回顾性病例分析方法。收集我院2018年5月—2020年12月期间行VV-ECMO治疗的全部58例重症肺炎患者的病历资料,按治疗结局,分为存活组和死亡组。记录并比较两组的基线资料、治疗参数和结局,分析启动时机和临床因素对预后的影响。计量资料组间比较采用t检验或非参数检验,计数资料采用χ^(2)检验。结果:30例存活,28例死亡,病死率48.3%。病因学方面,细菌性肺炎占40(69%)例次,流感病毒性肺炎11(19%)例次,其他7(12%)例次。两组差异无统计学意义(P>0.05)。VV-ECMO启动前,存活组和死亡组机械通气的中位数时间分别为(1 vs.2)d(P<0.05);启动前6 h内,两组的PaO2/FiO2分别为(60.54±16.69)mmHg(1 mmHg=0.133 kPa)和(69.22±18.95)mmHg(P>0.05);启动前24 h内,两组的APACHEⅡ评分分别为(28.43±7.77)分和(33.04±7.84)分(P<0.05)。统计显示,存活组从发病到ECMO启动的中位数时间显著低于死亡组,分别为(2 vs.5.5)d(P<0.05)。VV-ECMO治疗期间,两组的平均液体入量分别为(2118.53.0±386.04)和(2642.50±1251.02)mL/d,液体净平衡分别为(-802.20±530.08)和(265.94±2055.66)mL/d(均P<0.05)。存活组的血浆白蛋白水平、血红蛋白浓度、血小板计数,以及右美托咪定和舒芬太尼用量均高于死亡组(P<0.05)。预后方面,存活组和死亡组入住重症监护室(ICU)天数、住院天数均差异有统计学意义(P<0.05),但住院总费用差异无统计学意义(P>0.05)。结论:VV-ECMO启动指征除了参考前期的机械通气时间和氧合指数外,病程和疾病严重程度对预后也有显著性影响。准确把握启动时机有望进一步降低重症肺炎患者的病死率。优化液体管理、合理镇痛镇静、维持正常的血浆白蛋白和血红蛋白浓度可提高治疗的效果。
Objective:To explore the factors of venoveneous extracorporeal membrane oxygenation(VV-ECMO)therapy in patients with severe pneumonia.Methods:Medical records were reviewed retrospectively in 58 patients with severe pneumonia caused by a variety of etiologies who were treated with VV-ECMO in a tertiary teaching hospital from May 2018 to December2020.Patients were designated into survivor or non-survivor group according to their outcomes.Data of the demographic characteristics,clinical parameters and outcomes were collected and analyzed.Comparison of difference for quanlitative data was performed by using the Student t test or nonparametric test,and categorical data by the Chi-square test.P<0.05 was defined as statistical significance.Results:Thirty patients were survival and 28 died(48.3%).Forty-two cases were confirmed with bacterial pneumonia and 12 influenza viral lung infection,and no significant difference was found in etiological spectrum between the two groups(P>0.05).Prior to VV-ECMO,the median days were 1 day and 2 days from mechanical ventilation to ECMO initiation in the survivor and non-survior groups(P<0.05),respectively.Within 6 and 24 hours to VV-ECMO,the PaO2/FiO2were (60.54±16.69)and(69.22±18.95)mmHg(P>0.05)and the APACHEⅡscores were(28.43±7.77)and(33.04±7.84)points in the two groups(P<0.05),respectively.Moreover,data shown that the median days were 2 days and 5.5 days from attack of disease to VV-ECMO onset in the two groups(P<0.05),and the optimal timing of point was 4 days for VV-ECMO initiation,with more cumulative survival cases.During the period of VV-ECMO therapy,the averaged amount of fluid infusion was 2119 mL/d and 2643 mL/d,and the net fluid balance was-802.2 mL/d and 265.9 mL/d in the survivor and non-survivor groups,respectively(P<0.05).The blood platelet count,hemoglobin and plasma protein concentrations were higher,and the total dosages of sufentanil and dexmedetomidine were larger in the survivor group than in the non-survivor group(P<0.05).Finally,the time spent on VV-ECMO a
作者
何小贝
蔡靓
张晓程
王凯
康骊泉
常平
王华
HE Xiaobei;CAI Jing;ZHANG Xiaocheng;WANG Kai;KANG Liquan;CHANG Ping;WANG Hua(Division of Intensive Care Medicine,Zhujiang Hospital,Southern Medical University,Guangzhou,510282,China;Guangzhou Guanggang New City Hospital)
出处
《临床急诊杂志》
CAS
2021年第11期757-764,共8页
Journal of Clinical Emergency
基金
广东省科技计划项目(No:2014A020212670)
南方医科大学临床研究启动计划培育项目(No:LC2016PY036)。
关键词
重症肺炎
体外膜肺
回顾性分析
severe pneumonia
extracorporeal membrane oxygenation
Retrospective study
