急诊静脉-动脉体外膜肺氧合患者死亡危险因素分析  

Risk factors for death in emergency patients with veno-arterial extracorporeal membrane oxygenation

作　　者：谢婷[1] 邓磊[1] 李依 宋孟龙 田黎黎 张洋[1] 周平[1] Xie Ting;Deng Lei;Li Yi;Song Meng-long;Tian Li-li;Zhang Yang;Zhou Ping(Department of Emergency Intensive Care Unit,Sichuan Provincial People’s Hospital,the Affiliated Hospital of University of Electronic Science and Technology of China,Chengdu 610072,China)

机构地区：[1]电子科技大学附属医院四川省人民医院急救中心EICU,四川成都610072

出　　处：《中国急救医学》2021年第7期640-644,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨急诊静脉-动脉体外膜肺氧合(V-A ECMO)患者的危险因素。方法单中心回顾性分析2017年10月至2021年3月四川省人民医院急救中心70例V-A ECMO患者的临床资料,根据出院28 d是否存活分为生存组和死亡组,分析比较两组资料,采用KaplanMeier法绘制生存曲线,应用COX回归分析影响死亡的危险因素。结果共纳入病例70例,生存组22例,死亡组48例。与生存组比较,死亡组入院时急性生理与慢性健康状况评估系统Ⅱ(APACHEⅡ)评分、乳酸更高,ECMO流转后第1小时去甲肾上腺素用量更大,体外心肺复苏(ECPR)比例更高,ECMO建立时间更长,ECMO支持时间更短,差异均有统计学意义(P<0.05)。所有患者出院28 d的中位生存时间为3 d,ECPR患者较非ECPR患者28 d中位生存时间更短(2 d vs.15 d,log-rank=10.112,P<0.01)。COX回归分析显示,ECPR、ECMO流转后第1小时去甲肾上腺素用量大和入院APACHEⅡ评分高与V-A ECMO患者死亡的独立危险因素。结论ECPR、ECMO流转后第1小时去甲肾上腺素用量大、入院APACHEⅡ评分高与急诊V-A ECMO患者的预后密切相关。发现和处理高危因素是否有助于提高患者预后需进一步研究。Objective To analyze the clinical data of the patients with venous-arterial extracorporeal membrane oxygenation(V-A ECMO)and to explore the risk factors for death.Methods The clinical data of 70 patients with V-A ECMO in the emergency department of Sichuan Provincial People’s Hospital from October 2017 to March 2021 were reviewed in a single center.Patients were divided into survival group and death group according to whether they survived 28 days after the discharge.The survival curve was drawn by Kaplan-Meier method,and the risk factors of death were analyzed by Cox regression.Results A total of 70 cases were included,22 cases in survival group and48 cases in death group.Compared with the survival group,the death group had higher APACHEⅡscore on admission and lactic acid value,the larger dosage of norepinephrine in the first hour after ECMO circulation,the higher proportion of external cardiopulmonary resuscitation(ECPR),the longer time of ECMO establishment,the shorter ECMO auxiliary time,the difference between two groups was statistically significant(P<0.05).The median survival time of all the patients at 28 days after thedischarge was 3 days.ECPR patients had a shorter median survival time of 28 days than non-ECPR patients(2 d vs.15 d,log-rank=10.112,P<0.01).COX regression analysis showed that ECPR,the larger dosage of norepinephrine in the first hour after ECMO circulation and high APACHEⅡscore on admission were independent risk factors for death in the patients with V-A ECMO.Conclusions ECPR,the larger dosage of norepinephrine in the first hour after ECMO circulation and high APACHEⅡscore on admission are closely related to the prognosis of emergency patients with V-A ECMO.It is necessary to further study whether finding and dealing with high risk factors can improve the prognosis of patients.

关 键 词：体外膜肺氧合(ECMO) 心脏骤停 急诊科 危险因素 

分 类 号：R459.7[医药卫生—急诊医学]