心脏术后静脉-动脉体外膜氧合辅助患者血管并发症对预后的影响及危险因素分析  

Effect of vascular complications on prognosis and risk factors analysis in patients supported with veno-arterial extracorporeal membrane oxygenation after cardi⁃ac surgery

作　　者：徐博[1] 蔡彤 李呈龙[1] 杜中涛[1] 杨峰[1] 崔永超[1] 邢智辰[1] 辛萌[1] 王鹏程 江春景[1] 贾明[1] 王红[1] 侯晓彤[1] Xu Bo;Cai Tong;Li Chenglong;Du Zhongtao;Yang Feng;Cui Yongchao;Xing Zhichen;Xin Meng;Wang Pengcheng;Jiang Chunjing;Jia Ming;Wang Hong;Hou Xiaotong(Center for Cardiac Intensive Care,Beijing Institute of Heart Lung and Blood Vessels Diseases,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科危重症中心北京市心肺血管疾病研究所,北京100029

出　　处：《中国体外循环杂志》2021年第6期323-328,共6页Chinese Journal of Extracorporeal Circulation

基　　金：国家重点研发计划(2016YHC1301001);北京市医院管理中心临床医学发展专项项目(ZYLX202111);北京市医院管理中心“登峰”计划专项项目(FDL20190601)。

摘　　要：目的对接受静脉-动脉体外膜氧合(V-A ECMO)辅助的心脏术后心源性休克患者血管并发症的发生情况进行分析,评估血管并发症发生的危险因素以及对患者预后的影响。方法本研究为单中心回顾性研究,纳入2017年1月至2020年12月接受股静脉-股动静V-A ECMO辅助的成人心脏术后心源性休克(PCS)患者,根据有无血管并发症将患者分为两组,比较临床预后,并采用多因素分析确定血管并发症的危险因素。结果331例接受V-A ECMO治疗的PCS患者中,118例(35.6%)发生血管并发症,其中6例(1.8%)出现下肢缺血或插管处动脉血栓需手术干预,16例(4.8%)插管部位出血需要手术干预,其余96例(29.0%)出现轻度下肢缺血无须处理。年龄大于或等于60岁(OR 1.797,P=0.020)、ECMO前6 h血乳酸水平(OR 1.062,P=0.002)、ECMO前6 h序贯器官衰竭(SOFA)评分(OR 1.160,P=0.025)、单纯冠状动脉旁路移植术(CABG)(OR 0.576,P=0.032)与血管并发症相关。有和无血管并发症患者的住院生存率分别为22.9%和45.5%(P<0.001)。结论血管并发症与较高的住院死亡率相关。年龄大于或等于60岁、ECMO前6 h血乳酸水平及SOFA评分是发生血管并发症的独立危险因素,而单纯CABG术则为血管并发症发生的独立保护性因素。Objective This study was designed to analyze the incidence of vascular complications in patients with postcardioto⁃my cardiogenic shock(PCS)assisted by veno-arterial extracorporeal membrane oxygenation(VA ECMO),and to evaluate the risk factors of vascular complications and their impact on the prognosis of patients.Methods Adult PCS patients receiving femoral VA EC⁃MO from January 2017 to December 2020 were enrolled in this study.Patients were divided into two groups according to the presence or absence of vascular complications.Clinical outcomes were compared between the two groups.Multivariable logistic regression was per⁃formed to identify risk factors independently associated with vascular complications.Results Among 331 patients with PCS treated with VA ECMO,118(35.6%)had vascular complications,in which there were 6 patients(1.8%)with severe extremity ischemia or thrombosis needed surgical intervention,16 patients(4.8%)with uncontrolled bleeding needed surgical intervention,and 96 paitnets(29.0%)with mild extremity ischemia.Age≥60 years(OR 1.797,P=0.020),blood lactate level 6 hours before ECMO(OR 1.062,P=0.002),sequential organ failure assessment(SOFA)6 hours before ECMO(OR 1.160,P=0.025),and simple coronary artery bypass grafting(CABG)(OR 0.576,P=0.032)were associated with vascular complications.The in-hospital survival rates of patients with and without vascular complications were 22.9%and 45.5%,respectively(P<0.001).Conclusion Vascular complications was associated with higher in-hospital mortality among adult PCS patients receiving peripheral VA-ECMO support.Age≥60 years,blood lactate level 6 hours before ECMO,SOFA 6 hours before ECMO were independent risk factors for vascular complications,while CABG alone was an independent protective factor.

关 键 词：心源性休克 静脉-动脉 体外膜氧合 并发症 插管 结局 心脏手术 

分 类 号：R654.2[医药卫生—外科学]