静脉-动脉体外膜肺氧合治疗相关并发症回顾性分析  

Single-center retrospective analysis of complications related to venoarterial extracorporeal membrane oxygenation

作　　者：朱清一[1] 金啸天 漆能华 吴志坚 肖宜超[1] 台适[1] 周胜华[1] 唐建军[1] Zhu Qingyi;Jin Xiaotian;Qi Nenghua;Wu Zhijian;Xiao Yichao;Tai Shi;Zhou Shenghua;Tang Jianjun(Department of Cardiology,the Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院心内科,长沙410011

出　　处：《中华心力衰竭和心肌病杂志（中英文）》2022年第2期127-133,共7页Chinese Journal of Heart Failure and Cardiomyopathy

摘　　要：目的回顾分析静脉-动脉体外膜肺氧合(VA ECMO)治疗相关并发症发生情况及其影响因素。方法纳入2013年4月至2022年3月期间于中南大学湘雅二医院心内科进行VA ECMO治疗的病例,回顾性分析治疗相关并发症的发生情况、可能的影响因素及院内转归。结果共有204例患者纳入分析,VA ECMO撤机率为61.8%,患者院内总死亡率为62.7%。主要并发症的总发生率为93.1%,分别为肢体缺血44.1%、神经系统损害9.3%、溶血5.4%、出血34.3%、血小板降低90.2%、感染77.9%及器官功能不全73.5%。多因素logistic回归分析显示,发生上述并发症的患者死亡风险明显升高[比值比(OR)7.20,95%可信区间(CI)1.96~26.40,P=0.003],其中,肢体缺血(OR 2.55,95%CI 1.18~5.51,P=0.017)、感染(OR 3.22,95%CI 1.13~9.19,P=0.029)及器官功能不全(OR 5.08,95%CI 1.53~16.90,P=0.008)显著增加死亡风险。与未出现肢体缺血患者比较,出现肢体缺血患者的中性粒细胞百分比较高[(85.60±1.80)%比(90.25±0.80)%,P=0.021],凝血酶原时间百分活度(PT%)[(67.00±117.46)%比(36.64±18.15)%,P=0.031]和抗凝血酶III活性(AT-III%)[(54.46±25.09)%比(41.51±21.53)%,P=0.004]较低,差异均有统计学意义。使用血管活性药的比例在出现肢体缺血患者高于未出现肢体缺血患者,差异有统计学意义(68.9%比50.0%,P=0.009)。出现严重肢体缺血患者的动脉鞘管尺寸较未出现严重肢体缺血患者大,差异有统计学意义[17(16,17)F比16(16,16)F,P=0.033]。结论VA ECMO相关并发症发生率较高,与死亡密切相关,其中,肢体缺血、感染及器官功能不全可能是并发症导致死亡的重要因素。Objective To retrospectively analyze the incidence and influencing factors of complications associated with venoarterial extracorporeal membrane oxygenation(VA ECMO).Method Patients who received VA ECMO treatment in the in Department of Cardiology,Second Xiangya Hospital of Central South University from April 2013 to March 2022 were included.The incidence of VA ECMO-related complications,possible influencing factors and in-hospital prognosis were retrospectively analyzed.Results A total of 204 patients were included in the study.The weaning rate was 61.8%and the overall in-hospital mortality rate was 62.7%.The overall occurrence rate of complications was 93.1%,including 44.1%with limb ischemia,9.3%with neurological disorders,5.4%with hemolysis,34.3%with hemorrhage,90.2%with thrombocytopenia,77.9%with infection,and 73.5%with organ dysfunction.Multivariate logistic regression analysis showed that patients with complications had a significantly higher risk of death[odds ratio(OR)7.20,95%confidence interval(CI)1.96-26.40,P=0.003).Among them,limb ischemia(OR 2.55,95%CI 1.18-5.51,P=0.017),infection(OR 3.22,95%CI 1.13-9.19,P=0.029)and organ dysfunction(OR 5.08,95%CI 1.53-16.90,P=0.008)were significantly associated with death.Compared to those in patients without limb ischemia,the pencentage of neutrophils was significantly higher[(85.60±1.80)%vs.(90.25±0.80)%,P=0.021],the prothrombin time percentage activity(PT%)[(67.00±117.46)%vs.(36.64±18.15)%,P=0.031]and the antithrombin III activity(AT-III%)[(54.46±25.09)%vs.(41.51±21.53)%,P=0.004]were significantly lower in patients with limb ischemia.Moreover,the proportion of vasoactive agents in patients with limb ischemia was significantly higher than those in patients without limb ischemia(68.9%vs.50.0%,P=0.009).Size of the arterial sheath in patients with severe extremity ischemia was 17(16,17)F,which was significantly higher than that in other patients without severe extremity ischemia of 16(16,16)F(P=0.033).Conclusions The incidence of various complications of VA ECMO

关 键 词：静脉-动脉体外膜氧合 并发症 肢体缺血 

分 类 号：R459.7[医药卫生—急诊医学]