急性冠脉综合征致心源性休克患者静脉-动脉体外膜氧合治疗早期容量平衡与预后的相关性  

Study on the correlation between early fluid balance and prognosis of the patients with cardiogenic shock caused by acute coronary syndrome under veno-arterial extracorporeal membrane oxygenation

作　　者：孙峰 陈旭锋[1] 梅勇[1] 吕金如[1] 李伟[1] 胡德亮[1] 张刚[1] 张华忠[1] 张劲松[1] Sun Feng;Chen Xu-feng;Mei Yong;Lv Jin-ru;Li Wei;Hu De-liang;Zhang Gang;Zhang Hua-zhong;Zhang Jin-song(Emergency Department,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院急诊科,江苏南京210029

出　　处：《中国急救医学》2021年第3期206-209,共4页Chinese Journal of Critical Care Medicine

基　　金：睿E急诊医学研究专项基金资助项目(R2020012)。

摘　　要：目的分析急性冠脉综合征(acute coronary syndrome,ACS)导致的心源性休克患者使用静脉-动脉体外膜氧合(veno-arterial extracorporeal membrane oxygenation,VA-ECMO)治疗早期容量平衡与预后的相关性。方法本研究回顾自2015年3月至2020年11月接受VAECMO治疗的患者,筛选出VA-ECMO运行> 3 d并以ACS为病因的心源性休克患者。比较ACS患者与非ACS患者一般情况、联合连续肾脏替代治疗(continuous renal replacement therapy,CRRT)、主动脉内球囊反搏(intra-aortic balloon pump,IABP)及有创机械通气情况。统计ACS患者预后与前3 d每天容量平衡及总平衡的相关性。根据ACS患者的前3 d总容量的正负平衡分组,比较患者一般情况、肾功能指标及联合CRRT、IABP、有创机械通气的情况。结果入选32例患者。ACS患者与非ACS患者在年龄、性别比例、是否联合IABP治疗方面比较差异有统计学意义(P <0.05)。ACS患者根据前3 d每日容量平衡正负分组,正负两组存活率比较差异无统计学意义(P> 0.05);根据前3 d总容量平衡结果进行分组,两组存活率比较差异有统计学意义(20.0%vs. 58.8%,P <0.05),但两组年龄、性别比、VA-ECMO运转时间、肾功能变化比较差异无统计学意义(P>0.05),联合CRRT、IABP或有创通气等差异无统计学意义(P>0.05)。结论对于ACS导致的心源性休克患者,接受VA-ECMO支持治疗3 d以上时,前3 d总容量平衡呈负平衡的患者较正平衡患者存活概率更高。Objective To analyze the correlation between the early fluid balance and prognosis of the patients with cardiogenic shock caused by acute coronary syndrome( ACS) treated with veno-arterial extracorporeal membrane oxygenation( VA-ECMO). Methods This study reviewed the patients who received VA-ECMO treatment from March 2015 to November 2020 in our emergency center,and the ones with cardiogenic shock caused by ACS who had VA-ECMO operation for longer than 3 days were enrolled. The general conditions and the use of continuous renal replacement therapy( CRRT),intra-aortic balloon pump( IABP),and invasive mechanical ventilation were compared between ACS patients and non-ACS patients. For ACS patients,the correlation of the prognosis with the daily fluid balance and the cumulative fluid balance of the first three days was calculated. The ACS patients were grouped according to the 3-day cumulative fluid balance,and their general conditions,renal function indicators and the use of CRRT,IABP and invasive mechanical ventilation were compared between the two groups. Results 32 patients were enrolled. There were significant differences in age,gender,and IABP use between ACS and non-ACS patients( P < 0. 05). ACS patients were grouped according to the daily fluid balance for the first three days,and there was no difference in survival rate between the positive group and the negative group( P > 0. 05). Then they were grouped according to the3-day total fluid balance,and the difference in survival rate between the two groups was significant( 20. 0% vs. 58. 8%,P < 0. 05). There were no significant differences in age,gender,VA-ECMO operating time,renal function changes,and the use of CRRT,IABP or invasive ventilation( P > 0. 05).Conclusions For the patients with cardiogenic shock caused by ACS,when receiving VA-ECMO support for more than 3 days,the patients with negative cumulative fluid balance during the first three days are more likely to survive than patients with positive balance.

关 键 词：静脉-动脉体外膜氧合(VA-ECMO) 心源性休克 急性冠脉综合征(ACS) 容量平衡 预后 

分 类 号：R541.4[医药卫生—心血管疾病] R541.64[医药卫生—内科学]