摘要
目的分析因急性呼吸或循环衰竭行体外膜肺氧合(ECMO)治疗过程中的各类并发症及影响患者预后的危险因素。方法采用回顾性研究方法,收集2014年5月至2021年7月在厦门大学附属第一医院综合重症监护病房(ICU)因急性心肺功能不全等原因行ECMO支持且辅助时间>24 h的65例患者的临床资料,分析其治疗过程中的各类并发症和预后影响。结果65例ECMO支持患者中,其中静脉-动脉ECMO(VA-ECMO)23例,静脉-静脉ECMO(VV-ECMO)42例;成功脱机43例,撤机成功率66.15%;存活出院25例,平均存活率38.5%,其中VV-ECMO 40.5%,VA-ECMO 34.8%。ECMO并发症主要为患者相关并发症(58例,89.2%),其次为操作相关并发症(7例,10.7%)和机器相关并发症(3例,4.6%);VA-ECMO神经系统并发症显著高于VV-ECMO(21.7%比4.8%,P=0.03),VA-ECMO组急性肾损伤(AKI)发生率亦显著高于VV-ECMO组(82.6%比47.6%,P=0.006);VA-ECMO菌血症发生率明显低于VV-ECMO组(13.0%比38.1%,P=0.03),院内获得性肺炎(HAP)发生率亦显著低于VV-ECMO组(8.7%比52.4%,P<0.001)。多因素Cox分析结果显示,有基础疾病患者死亡风险是无基础疾病患者的2.81倍〔95%可信区间(95%CI)为1.31~6.01,P=0.008〕;ECMO前血乳酸(Lac)水平是患者死亡的独立危险因素,Lac水平越高,患者死亡风险越高〔校正风险比(HR)=1.13,95%CI为1.06~1.20〕,但有HAP者的死亡风险却低于无HAP者(校正HR=0.20,95%CI为0.08~0.51,P=0.001)。结论ECMO作为严重心肺功能衰竭患者挽救性的治疗手段,仍存在较多的并发症,而VA-ECMO和VV-ECMO不同模式下的并发症也不尽相同;ECMO患者预后与基础病、术前Lac水平相关;合并HAP的患者死亡风险较低,可能以VV-ECMO治疗为主、住院时间较长有关,需进一步研究证实。
Objective To analyze the various complications and risk factors affecting the prognosis of patients treated with extracorporeal membrane oxygenation(ECMO)for acute respiratory and/or circulatory failure.Methods Using retrospective research methods,clinical data were collected from 65 patients who underwent ECMO support for acute cardiopulmonary insufficiency from May 2014 to July 2021 in the General intensive care unit(ICU)of the First Affiliated Hospital of Xiamen University,and the duration of assistance was more than 24 hours.All kinds of complications and prognosis were analyzed.Results Among the 65 patients treated with ECMO,23 cases were on veno-arterial ECMO(VA-ECMO)and 42 cases were on veno-venous ECMO(VV-ECMO).Forty-three patients were successfully discharged(66.15%withdrawal rate),and 25 cases were discharged alive,with an average survival rate of 38.5%.ECMO complications were in order of patient-related complications(58 cases,89.2%),followed by operationrelated complications(7 cases,10.7%)and machine-related complications(3 cases,4.6%).Neurological complications were significantly higher in VA-ECMO than those in VV-ECMO(21.7%vs.4.8%,P=0.03),and the incidence of acute kidney injury(AKI)was also significantly higher in the VA-ECMO group than that in the VV-ECMO group(82.6%vs.47.6%,P=0.006).Whereas the incidence of bacteremia in the VA-ECMO group was significantly lower than that in the VV-ECMO group(13.0%vs.38.1%,P=0.03),and the incidence of hospital-acquired pneumonia(HAP)was also significantly less than that in the VV-ECMO group(8.7%vs.52.4%,P<0.001).A multivariate Cox analysis showed that the risk of death in patients with underlying disease was 2.81 times that of those without underlying disease(95%CI was 1.31-6.01,P=0.008).The pre-ECMO blood lactate(Lac)level was an independent risk factor for death[corrected hazard ratio(HR)=1.13,95%CI was 1.06-1.20],but the risk of death was lower in those with HAP than in those without HAP(corrected HR=0.20,95%CI was 0.08-0.51,P=0.001).Conclusions As a salvage tr
作者
卢桂阳
徐颢
宁耀贵
陈净珂
张民伟
Lu Guiyang;Xu Hao;Ning Yaogui;Chen Jingke;Zhang Minwei(Department of Critical Care Medicine,The First Affiliated Hospital of Xiamen University,Xiamen 361003,Fujian,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2021年第6期697-701,共5页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
关键词
体外膜肺氧合
并发症
预后
危险因素
Extracorporeal membrane pulmonary oxygenation
Complications
Prognosis
Risk factor
