上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2023, Vol. 43 ›› Issue (12): 1529-1534.doi: 10.3969/j.issn.1674-8115.2023.12.007

• 论著 · 临床研究 • 上一篇    

体外膜肺氧合在院内成人心源性休克和心脏骤停中的应用研究

隋明亮(), 汤卫兵, 吴长江, 黄超发, 杨雅迪, 夏大梅()   

  1. 上海交通大学医学院苏州九龙医院重症医学科，苏州 215028
  • 收稿日期:2023-04-24 接受日期:2023-10-31 出版日期:2023-12-28 发布日期:2024-02-01
  • 通讯作者: 夏大梅 E-mail:sml13451648826@163.com;hfutsix@163.com
  • 作者简介:隋明亮（1981—），男，副主任医师，硕士；电子信箱：sml13451648826@163.com。
  • 基金资助:
    苏州市科技发展计划（民生科技-医疗卫生应用基础研究）基金(SYSD2018064)

Application of extracorporeal membrane oxygenation to adults with cardiogenic shock and cardiac arrest in hospital

SUI Mingliang(), TANG Weibing, WU Changjiang, HUANG Chaofa, YANG Yadi, XIA Damei()   

  1. Department of Critical Care Medicine, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou 215028, China
  • Received:2023-04-24 Accepted:2023-10-31 Online:2023-12-28 Published:2024-02-01
  • Contact: XIA Damei E-mail:sml13451648826@163.com;hfutsix@163.com
  • Supported by:
    Suzhou Science and Technology Development Plan (Minsheng Technology-Medical and Health Applied Basic Research) Foundation(SYSD2018064)

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摘要：

目的·评估院内心源性休克和心脏骤停患者使用静脉动脉体外膜肺氧合（veno-arterial extracorporeal membrane oxygenation，VA-ECMO）救治对其病死率的影响。方法·选择2017年9月—2022年3月期间在上海交通大学医学院苏州九龙医院行VA-ECMO救治的19例心源性休克和心脏骤停患者。根据VA-ECMO实施前是否发生心脏骤停，将其分为体外心肺复苏组（extracorporeal cardiopulmonary resuscitation，ECPR）组（n=9）和常规VA-ECMO（VA-ECMO for cardiogenic shock，E-CS）组（n=10）。收集2组患者的一般人口学资料、临床资料、序贯器官衰竭评估（Sequential Organ Failure Assessment，SOFA）评分、术后并发症及预后指标资料。采用单因素、多因素Cox比例风险回归模型评估各协变量与住院病死率之间的关联性。结果·纳入的患者中男性15例（78.9%），平均年龄为46.5（34.5，61.6）岁；术后并发症的发生率依次为：出血47.4%、急性肾损伤36.8%、感染31.6%、肢体缺血15.8%和脑血管意外5.3%；VA-ECMO持续时间为4.0（2.0，6.8）d，ICU监护时间为11.5（5.8，26.2）d；ECMO撤机成功率为63.2%，住院病死率为63.2%。单因素Cox比例风险回归的结果显示，术前发生急性肾损伤、术后感染和肢体缺血与患者的住院病死率相关（均P<0.05）。多因素Cox比例风险回归的结果显示，术前发生急性肾损伤、术后感染和肢体缺血亦是患者住院病死率的独立危险因素（均P<0.05）。结论·对于行VA-ECMO救治的心源性休克和心脏骤停患者，术前发生急性肾损伤、术后感染和肢体缺血与较高的住院病死率独立相关。

关键词: 静脉动脉体外膜肺氧合, 体外心肺复苏, 心源性休克, 心脏骤停, 住院病死率

Abstract:

Objective ·To assess the effect of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) treatment on the mortality rate of patients suffering from cardiogenic shock and cardiac arrest in hospital. Methods ·A total of 19 patients with cardiogenic shock or cardiac arrest who were treated with VA-ECMO treatment in Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine from September 2017 to March 2022 were included in the retrospective study. Patients were divided into extracorporeal cardiopulmonary resuscitation (ECPR) group (n=9) and VA-ECMO for cardiogenic shock (E-CS) group (n=10) according to whether cardiac arrest had occurred. The general demographic data, clinical data, Sequential Organ Failure Assessment (SOFA) scores, postoperative complications and prognostic indicators of the two groups of patients were collected. Univariate and multivariate Cox proportional hazard regression analyses were used to evaluate the correlation between each covariate and hospital mortality. Results ·Among the included patients, there were 15 males (78.9%), with an average age of 46.5 (34.5, 61.6) years. The incidence of postoperative complications was as follows: bleeding (47.4%), AKI (36.8%), infection (31.6%), limb ischemia (15.8%) and cerebrovascular accident (5.3%). The duration of VA-ECMO was 4.0 (2.0, 6.8) days, and the intensive care duration was 11.5 (5.8, 26.2) days; the ECMO withdrawal success rate was 63.2%, and the hospital mortality was 63.2%. The results of univariate Cox proportional hazard regression analysis showed that AKI (prior to VA-ECMO initiation), postoperative complications of infection and limb ischemia were correlated with the hospital mortality of patients (all P<0.05). The results of multivariate Cox proportional hazard regression analysis showed that AKI (prior to VA-ECMO initiation), postoperative complications of infection and limb ischemia were also independent risk factors for the hospital mortality of patients (all P<0.05). Conclusion ·For patients with cardiogenic shock and cardiac arrest treated with VA-ECMO, AKI (prior to VA-ECMO initiation), postoperative infection and limb ischemia are independently associated with higher hospital mortality.

Key words: veno-arterial extracorporeal membrane oxygenation (VA-ECMO), extracorporeal cardiopulmonary resuscitation (ECPR), cardiogenic shock (CS), cardiac arrest (CA), hospital mortality

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