78例体外心肺复苏患者的临床特点回顾性分析  

Retrospective analysis of clinical characteristics of 78 patients receiving extracorporeal cardiopulmonary resuscitation

作　　者：李伟 张劲松 陈旭锋 梅勇 吕金如 胡德亮 孙峰 张刚 张华忠 黄夕华 张慧 王维惟 Li Wei;Zhang Jinsong;Chen Xufeng;Mei Yong;Lv Jinru;Hu Deliang;Sun Feng;Zhang Gang;Zhang Huazhong;Huang Xihua;Zhang Hui;Wang Weiwei(Department of Emergency Medicine,the First Affiliated Hospital of Nanjing Medical University(Jiangsu Provincial People's Hospital),Nanjing 210029.China)

机构地区：[1]南京医科大学第一附属医院(江苏省人民医院)急诊医学科,210029

出　　处：《中华急诊医学杂志》2021年第10期1187-1191,共5页Chinese Journal of Emergency Medicine

基　　金：江苏省医学创新团队(CXTDA2017007);江苏省“六大人才高峰”(2019WSN-005);江苏省“六个一工程”拔尖人才(LGY20190688);江苏省人民医院“511腾飞工程”(2018)。

摘　　要：目的总结体外膜肺氧合辅助心肺复苏患者(extracorporeal cardiopulmonary resuscitation,ECPR)的临床特点并分析临床结局的影响因素。方法回顾性纳入2015年03月至2020年12月南京医科大学第一附属医院(江苏省人民医院)急诊医学科收治的ECPR患者78例。根据患者的临床结局分为存活组和死亡组。分别比较两组的基本资料,CPR资料及ECPR启动前实验室检验。结果共纳入ECPR患者78例、男性51例、女性27例,存活23例,其中男性10例,女性13例。组间患者年龄、体质量指数、基础疾病(高血压病、糖尿病、冠心病)均差异无统计学意义(均P>0.05)。存活组男性患者比例低于死亡组(P=0.017)。同时存活组患者SAVE(survival after veno-arterial ECMO)评分显著高于死亡组[(-1.57±4.15)us.(-9.36±5.36),P<0.001].存活组中旁观者心肺复苏比例高于死亡组(P=0.014)。存活组ECPR启动前存活组血清AST.ALT、Cr水平均低于死亡组(P<0.05)。二分类多因素Logistic回归分析结果显示旁观者心肺复苏(OR=0.114,95%CI:0.015~0.867,P=0.036)和SAVE评分(OR=0.625,95%CI:0.479~0.815,P=0.001)是预测ECPR患者ICU死亡的独立危险因素。结论单中心资料显示ECPR是教治呼吸心搏骤停患者的有效手段,旁观者心肺复苏、SAVE评分是预测ECPR患者ICU死亡的独立危险因素。Objective To summarize the clinical characteristics and influencing factors on clinical outcome of patients receiving extracorporeal cardiopulmonary resuscitation(ECPR).Methods A total of78 patients receiving ECPR admitted to the Department of Emergency Medicine of the First Affiliated Hospital of Nanjing Medical University(Jiangsu Provincial People's Hospital)from March 2015 to December 2020 were retrospectively enrolled.Patients were divided into the survival group and death group according to clinical outcome.Their baseline data,CPR associated parameters,and pre-ECPR laboratory tests were compared between the two groups.Results Of the 78 included patients,51 patients were male and 27 female.Twenty-three patients finally survived,including 10 males and 13 females.There were no significant differences in age,body mass index and underlying diseases(hypertension,diabetes and coronary heart disease)between the two groups(all P>0.05).The proportion of male patients in the survival group was lower than that in the death group(P=0.017).Meanwhile Survival After Veno-Arterial ECMO(SAVE)score was significantly higher in the survival group than that in the death group[(-1.57±4.15)vs.(-9.36±5.36),P<0.001].The proportion of by-stander CPR in the survival group was higher than that in the death group(P=0.014).The pre-ECPR serum AST,ALT,and Cr levels in the survival group were significantly lower than those in the death group(all P<0.05).Logistic regression analysis showed that by-stander CPR(OR=0.114,95%CI:0.015-0.867,P=0.036)and SAVE score(OR=0.625,95% CI:0.479-0.815,P=0.001)were independent risk factors predicting ICU death in patients receiving ECPR.Conclusions ECPR is an efficient tool to improve clinical outcomes of patients with cardiac arrest.By-stander CPR and SAVE score are independent risk factors predicting ICU death in patients receiving ECPR.

关 键 词：体外膜肺氧合辅助心肺复苏 呼吸心搏骤停 SAVE评分 

分 类 号：R459.7[医药卫生—急诊医学]