静脉-静脉体外膜肺氧合治疗重度急性呼吸窘迫综合征的影响因素  

Related factors of veno-venous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome

作　　者：谭营帅 曹凤安 李军[2] 李鋆璐 孙孟飞 段甲利 刘洋[1] 邢丽华[1] Tan Ying-shuai;Cao Feng-an;Li Jun;Li Jun-lu;Sun Meng-fei;Duan Jia-li;Liu Yang;Xing Li-hua(Department of Respiratory and Intensive Care Unit,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;不详)

机构地区：[1]郑州大学第一附属医院呼吸与危重症医学科,河南郑州450000 [2]郑州大学第一附属医院心血管外科,河南郑州450000

出　　处：《中国急救医学》2021年第12期1023-1027,共5页Chinese Journal of Critical Care Medicine

基　　金：国家自然科学基金资助项目(82074212);河南省医学科技攻关计划省部共建项目(SB201901036)。

摘　　要：目的探讨静脉-静脉体外膜肺氧合(V-V ECMO)治疗重度急性呼吸窘迫综合征(ARDS)的影响因素。方法采用回顾性观察研究方法,收集并分析2018年1月至2020年7月郑州大学第一附属医院收治的60例接受V-V ECMO治疗的重度ARDS患者临床资料,根据出院情况分为好转组和恶化组。采用SPSS 26.0统计分析两组治疗前后的临床资料,经Logistic回归分析确定V-V ECMO治疗重度ARDS患者预后的影响因素。结果共60例重度ARDS患者接受V-V ECMO治疗,其中好转组32例,恶化组28例。单因素分析表明,吸烟史、应用ECMO前机械通气时间、血白细胞计数、需行持续肾脏替代治疗(CRRT)、发生多器官功能障碍综合征(MODS)及凝血功能障碍可能是预后的影响因素(P均<0.05);二元Logistic回归分析发现,血白细胞计数、应用ECMO后48 h机械通气PEEP、发生MODS及凝血功能障碍是预后的独立危险因素。结论血白细胞计数、应用ECMO后48 h机械通气PEEP、发生MODS及凝血功能障碍是影响V-V ECMO治疗重度ARDS患者预后的独立危险因素。Objective To investigate related factors of veno-venous extracorporeal membrane oxygenation(V-V ECMO)for the patients with severe acute respiratory distress syndrome(ARDS).Methods The clinical data of 60 patients with severe ARDS,who received V-V ECMO in the First Affiliated Hospital of Zhengzhou University from January 2018 to July 2020,were retrospectively collected and analyzed.The patients were divided into the improved group and the deteriorated group according to the discharge status.The statistics software of SPSS 26.0 was used for data analysis.Logistic regression analysis was performed to determine the risk factors affecting the prognosis of patients with severe ARDS treated with V-V ECMO.Results A total of 60 patients were enrolled in the study,including 32 patients in the improved group and 28 patients in the deteriorated group.Univariate analysis showed that smoking history,mechanical ventilation time before the application of ECMO,white blood cell count,need for continuous renal replacement therapy(CRRT),multiple organ dysfunction syndrome(MODS)and coagulation disorders might be the influencing factors of prognosis(all P<0.05).Binary Logistic regression analysis showed that white blood cell count,positive end expiratory pressure(PEEP)level of mechanical ventilation 48 h after the application of ECMO,MODS and coagulation disorders were independent risk factors.Conclusions For the patients with severe ARDS treated with V-V ECMO,the risk factors influencing the prognosis were white blood cell count,PEEP level of mechanical ventilation 48 h after the application of ECMO,MODS and coagulation disorders.

关 键 词：体外膜肺氧合(ECMO) 急性呼吸窘迫综合征(ARDS) 成人 肺 

分 类 号：R563.8[医药卫生—呼吸系统]