影响体外膜肺氧合救治成人心源性休克预后的因素分析  

Risk factors affecting the prognosis of adult cardiogenic shock patients treated with extracorporeal membrane oxygenation

作　　者：侯六生[1] 谢钢[1] 蒋崇慧[1] 袁勇[1] 李斌飞[1] 郑伟华[1] 宁晔[1] 赵双彪[1] 

机构地区：[1]中山大学附属中山医院,中山市急救中心,广东省中山528403

出　　处：《中华急诊医学杂志》2012年第5期510-513,共4页Chinese Journal of Emergency Medicine

基　　金：基金项目：广东省社会发展领域科技计划项目（63119）

摘　　要：目的总结中山大学附属中山医院体外膜肺氧合（extracorporealmembraneoxygenation，ECMO）在成人心源性休克（cardiogenicshock，CS）中的临床救治经验，分析影响患者预后的危险因素。方法回顾性分析中山大学附属中山医院2003年1月至2010年12月因药物和（或）主动脉内球囊反搏无效而行ECMO辅助的CS患者的临床资料，将合并严重颅脑损伤、晚期恶性肿瘤及多脏器功能衰竭的患者排除在外，据出院时的预后将其分为康复出院组与院内死亡组，先通过组间单因素分析筛选出影响预后的可能危险因素，再通过多因素Logistic回归分析确定影响预后的独立危险因素。结果辅助时间（41．56±43．07）h，31例成功脱机，22例康复出院，与预后有关的独立危险因素有年龄、ECMO前血乳酸水平、ECMO前心脏射血分数、弥漫f生血管内凝血、肾功能衰竭及多器官功能衰竭（P〈0．05）。结论ECMO患者心功能的可逆性及其并发症的严重程度是决定预后的主要因素，尽早识别及防治影响预后的危险因素是提高救治成功率的关键。Objective To find out risk factors affecting the prognosis of adult cardiogenic shock patients treated with extracorporeal membrane oxygenation . Methods From January 2003 to December 2010, patients with cardiogenic shock required veno-arterial ECMO after failure of conventional therapy and intra-aortic balloon pump counterpulsation therapy were retrospectively studied. Patients with severe traumatic brain injury, advanced malignancies and multiple organ failure were excluded. All patients were divided into survival group and death group. The risk factors were found out using one-way ANOVA and a multivariate logistic regression analysis was used to determine independent factors associated with survival. Results Thirty-one patients successfully weaned from ECMO. Twenty-two patients were successfully discharged. The average duration of ECMO was 41.56 ± 43.07 hours. Factors associated with failure of hospital discharge were age, pre-ECMO levels of ejection fraction, pre-ECMO levels of lactate, disseminated intravascular coagulation, renal failure and multiorgan failure （P 〈 0. 05）. Conclusions Irreversible heart failure and the complications are significantly correlated with survival, and the early use of ECMO for cardiogenic shock and recognize the factors are key to the success of ECMO treatment.

关 键 词：体外膜肺氧合 心源性休克 危险因素 预后 

分 类 号：R541.64[医药卫生—心血管疾病]