体外膜肺氧合辅助下高危复杂冠脉病变介入治疗的临床结局影响因素  

Factors influencing of the clinical outcome of interventional therapy for complex high-risk indicated coronary artery disease assisted by extracorporeal membrane oxygenation

作　　者：赵文龙 毛云 郑璐[1] 徐亚威 韩彬 赵荫涛[1] 赵晓燕[1] 杨海波[1] Zhao Wenlong;Mao Yun;Zheng Lu;Xu Yawei;Han Bin;Zhao Yintao;Zhao Xiaoyan;Yang Haibo(Cardiology Department,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院心血管内科,郑州450052

出　　处：《中华急诊医学杂志》2023年第5期655-659,共5页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金青年科学基金项目(81800377)。

摘　　要：目的探究体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)辅助高危复杂冠脉病变介入治疗(complex high-risk indicated patients percutaneous coronary intervention,CHIPPCI)临床结局的影响因素。方法回顾性收集2018年4月至2022年4月于郑州大学第一附属医院采用ECMO辅助下行CHIP-PCI患者的临床资料进行分析。根据患者院内存活情况分为存活组和死亡组,比较存活组和死亡组的基础情况、冠脉病变情况、ECMO使用情况、血制品与药物使用情况。计算ECMO使用前后24 h的与疗效相关的生化检验指标的变化率,使用秩和检验对生化检验指标变化率进行单因素分析,筛选差异有统计学意义的变量纳入多因素Logistic回归模型,分析影响患者预后的因素。结果共纳入使用ECMO辅助下完成CHIP-PCI患者67例:存活组(36例)ECMO使用时间59(41,87)h,连续肾脏替代治疗9例,使用主动脉内球囊反搏11例;死亡组(31例)ECMO使用时间31(19,80)h,连续肾脏替代治疗12例,使用主动脉内球囊反搏10例。存活组CTOs病变患者比例低于死亡组、存活组ECMO使用时间较长(均P<0.05)。多因素Logistic回归结果示,24 h的乳酸变化率(OR=2.864,95%CI:1.185~6.918,P=0.019)、肾小球滤过率变化率(OR=0.050,95%CI:0.003~0.871,P=0.040)、D-二聚体变化率(OR=1.497,95%CI:1.044~2.146,P=0.028)、结合胆红素变化率(OR=2.617,95%CI:1.121~6.111,P=0.026)与患者院内死亡风险相关。结论ECMO辅助下CHIP-PCI后24 h内乳酸、D-二聚体及结合胆红素下降速率快,24 h内肾小球滤过率快速恢复与CHIP院内死亡风险降低相关。Objective To explore the factors influencing the clinical outcome of complex high-risk indicated patients percutaneous coronary intervention(CHIP-PCI)assisted by extracorporeal membrane oxygenation(ECMO).Methods The clinical data of patients with CHIP-PCI assisted by ECMO in the First Affiliated Hospital of Zhengzhou University from April 2018 to April 2022 were retrospectively collected and analyzed.Patients were divided into the survival and death groups according to the in-hospital survival status.The baseline characteristic,the results of coronary angiography,and the use of ECMO,blood products and drug were compared between the two groups.The 24-h rate of change of biochemical test indicators after the use of ECMO were calculated and the univariate analysis was analyzed using rank sum test.According to the univariate analysis,the variables(P<0.05)were included in multivariate logistic regression to analyze the factors affecting the clinical outcomes of patients.Results A total of 67 CHIP patients who completed PCI with ECMO were included.In the survival group(n=36),the duration of ECMO treatment was 59(41,87)h,9 cases received continuous renal replacement therapy,and 11 cases received IABP.In the death group(n=31),the duration of ECMO treatment was 31(19,80)h,12 cases received continuous renal replacement therapy and10 cases received IABP.The proportion of patients with chronic total occlusion lesions(CTOs)in the survival group was lower than that in the death group,the duration of ECMO of the survival group was longer than that of the death group(P<0.05).Multivariate logistic regression analysis showed that 24-h lactate change rate(OR=2.864,95%CI:1.185-6.918,P=0.019),24-h eGFR change rate(OR=0.050,95%CI:0.003-0.871,P=0.040),24-h D-dimer change rate(OR=1.497,95%CI:1.044-2.146,P=0.028)and 24-h direct bilirubin change rate(OR=2.617,95%CI:1.121-6.111,P=0.026)were associated with in-hospital mortality.Conclusions Within 24 h after CHIP-PCI assisted by ECMO,the rapid decline in lactic acid,D-dimer and direct bilir

关 键 词：高危复杂冠脉病变 体外膜肺氧合 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]