摘要
目的 探讨心肌标志物血清高敏肌钙蛋白I(hs-cTnI)、肌酸激酶同工酶(CK-MB)及左室射血分数(LVEF)用于评估体外膜肺氧合辅助心肺复苏(extracorporeal cardiopulmonary resuscitation, ECPR)撤机成功的预测价值。方法 回顾性分析2017年2月至2021年10月在十堰市太和医院接受静脉-动脉体外膜肺氧合(veno-arterial extracorporeal membrane oxygenation, VA-ECMO)治疗的ECPR患者临床资料,根据撤机结局分为撤机成功组(n=26)和撤机失败组(n=36),使用非参数检验分析两组患者VA-ECMO启动前、撤机前及撤机后的血清hs-cTnI、CK-MB及LVEF差异。将具有临床意义和单因素分析中差异有统计学意义的指标与临床结局进行二元多因素Logistic回归分析;绘制受试者工作特征(ROC)曲线,计算ROC曲线下面积(AUC),并确定心肌标志物最佳截断值及预测撤机结局的敏感度和特异度。结果 62例接受VA-ECMO治疗的ECPR患者被纳入本研究,撤机成功率41.9%(26/62)。启动前撤机成功组血清CK-MB[86(43.5~146.0)U/L]小于撤机失败组[618.5(177.8~1225.3)U/L],撤机成功组LVEF[35.0%(27.8%~40.5%)]大于撤机失败组[29.5%(20.3%~33.8%)],差异有统计学意义(P<0.05);撤机前撤机成功组血清CK-MB[24.5(17.2~60.5)U/L]、hs-cTnI[4.6(0.9~8.9)ng/mL]小于撤机失败组CK-MB[759.5(517.8~1520.2)U/L]、hs-cTnI[31.7(9.3~75.2)ng/mL],撤机成功组LVEF[41.5%(33.3%~48.0%)]大于撤机失败组[29%(19.3%~32.0%)],差异有统计学意义(P<0.05)。撤机成功组撤机前血清hs-cTnI[4.6(0.9~8.9)ng/mL]、CK-MB[24.5(17.2~60.5)U/L]和撤机后血清hs-cTnI[1.5(0.4~3.9)ng/mL]、CK-MB[14(9.5~32.75)U/L]较启动前血清hs-cTnI[12.7(1.8~23.3)ng/mL]、CK-MB[86.0(43.5~146.0)U/L]下降,撤机成功组撤机前LVEF[41.5%(33.3%~48.0%)]和撤机后LVEF[53.5%(45.8%~56.5%)]较启动前LVEF[35.0%(27.8%~40.5%)]增加,差异有统计学意义(P<0.05)。撤机失败组撤机前血清hs-cTnI[31.7(9.3~75.2)ng/mL]、CK-MB[759.5(517.8~1520.2)U/L]较启动前血清hs-cTnI[12.3(4.2~50.0)ng/mL
Objective To investigate the predictive value of myocardial markers [high-sensitivity cardiac troponin I(hs-cTnI), creatine kinase isoenzyme(CK-MB), left ventricular ejection fraction(LVEF)]for successful weaning in the patients undergoing extracorporeal cardiopulmonary resuscitation(ECPR). Methods The clinical data of ECPR patients who received veno-arterial extracorporeal membrane oxygenation(VA-ECMO) treatment in Taihe Hospital of Shiyan City from February 2017 to October 2021 were retrospectively analyzed. According to the weaning outcome, they were divided into successful weaning group(n=26) and failed weaning group(n=36). Non-parametric test was used to analyze the differences of hs-cTnI, CK-MB and LVEF between the two groups in different times.The parameters with clinical significance and significant difference in univariate analysis were analyzed by binary multivariate Logistic regression analysis. Meanwhile, receiver operating characteristic(ROC) curve was drawn, the area under ROC curve was analyzed, and the sensitivity and specificity of predicting the weaning outcome, optimal cut-off value of myocardial markers were determined. Results 62 ECPR patients treated with VA-ECMO were included in this study with a weaning success rate of 41.9%(26/62). The CK-MB of the successful weaning group[86(43.5-146.0)U/L] was lower than that of the failed weaning group[618.5(177.8-1225.3)U/L], and the LVEF of the successful weaning group[35%(27.8%-40.5%)]was higher than that of the failed weaning group[29.5%(20.3%-33.8%)]before initiation, and the difference was statistically significant(P<0.05).The CK-MB[24.5(17.2-60.5)U/L]and hs-cTnI[4.6(0.9-8.9)ng/mL] of the successful weaning group were lower than those of the failed weaning group CK-MB[759.5(517.8-1520.2)U/L], hs-cTnI[31.7(9.3-75.2)ng/mL], and the LVEF of the successful weaning group[41.5%(33.3%-48.0%)] was higher than that of the failed weaning group[29.0%(19.3%-32.0%)] before weaning, and the difference was statistically significant(P<0.05).The hs-cTnI[4.6(0.9-8
作者
黄明菁
柴林
李昌盛
晏奎
周江
赵知文
方志成
Huang Ming-jing;Chai Lin;Li Chang-sheng;Yan Kui;Zhou Jiang;Zhao Zhi-wen;Fang Zhi-cheng(Postgraduate Training Base of Shiyan Taihe Hospital of Hubei Medical College,Shiyan 442000,China)
出处
《中国急救医学》
CAS
CSCD
2023年第3期202-206,共5页
Chinese Journal of Critical Care Medicine
基金
十堰市科学技术局基金项目(19Y32)
十堰市科学技术局基金项目(19Y36)。
