无乳酸碱剩余对体外膜肺氧合治疗患者预后的预测价值  

Study on the predictive value of alactic base excess in the patients receiving extracorporeal membrane oxygenation

作　　者：胡珊珊 黄国庆[1] 周利平[1] 李湘民[1] 牛旭平 杨宁[1] 伍平[1] 佘长寿 赵震 韩鑫 方振根 汤杰 麦钊 莫晓叶[1] Hu Shanshan;Huang Guoqing;Zhou Liping;Li Xiangmin;Niu Xuping;Yang Ning;Wu Ping;She Changshou;Zhao Zhen;Han Xin;Fang Zhengen;Tang Jie;Mai Zhao;Mo Xiaoye(Department of Emergency,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院急诊科,湖南长沙410008 [2]吐鲁番市人民医院急诊科,新疆吐鲁番838300

出　　处：《中国急救医学》2023年第8期614-619,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的分析无乳酸碱剩余对接受体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)治疗的急危重症患者预后的预测价值。方法回顾性分析2020年1月至2023年4月中南大学湘雅医院收治的104例ECMO支持的患者,根据住院期间28 d内患者是否死亡分组,比较两组患者的临床、实验室指标和无乳酸碱剩余的差异,应用COX回归分析影响预后的危险因素,采用Kaplan-Meier法绘制生存曲线,log-rank检验比较生存差异。结果共纳入病例96例,其中生存组32例,死亡组64例。与生存组比较,死亡组年龄、上机前急性生理与慢性健康状况评分(acute physiology and chronic health evaluation,APACHE)Ⅱ、序贯器官衰竭评分更高,ECMO转机后24 h乳酸和乳酸脱氢酶更高,标准碱剩余和无乳酸碱剩余更低,差异均有统计学意义(P<0.05)。COX回归分析显示,APACHEⅡ评分(OR 2.48,P=0.03)和ECMO转机后24 h无乳酸碱剩余<-3 mmol/L(OR 2.87,P=0.02)是ECMO治疗患者28 d死亡的危险因素。结论ECMO转机后24 h无乳酸碱剩余负值与ECMO患者的预后密切相关。Objective To assess the predictive value of alactic base excess in the prognosis of critically ill patients undergoing extracorporeal membrane oxygenation(ECMO).Methods A retrospective analysis was performed for 104 ECMO-supported patients admitted to Xiangya Hospital of Central South University from January 2020 to April 2023,and grouped according to whether the patients died within 28 days of hospitalization.The differences in clinical and laboratory indicators and alactic base excess between the two groups were compared.COX regression was used to analyze the risk factors affecting the prognosis,the Kaplan-Meier method was used to plot the survival curve,and the Log-rank test was used to compare the survival differences.Results A total of 96 cases were included,32 cases in survival group and 64 cases in death group.Compared with survival group,death group had the elder age,the higher acute physiology and chronic health evaluationⅡ(APACHEⅡ)score and sequential organ failure assessment(SOFA)score before ECMO,and the higher lactate dehydrogenase and lactic acid,the lower standard base excess and alactic base excess in the first 24 h after ECMO circulation,the differences between two groups were statistically significant(P<0.05).COX regression analysis revealed that the APACHEⅡscore(OR=2.48,P=0.03)and alactic base excess<-3 mmol/L in the first 24 h after ECMO circulation(OR=2.87,P=0.02)were independent risk factors for 28-day death in the patients with ECMO.Conclusions The prognosis of patients with ECMO is closely correlated with the negative value of alactic base excess in the first 24 h after ECMO circulation.

关 键 词：体外膜肺氧合(ECMO) 院内死亡 无乳酸碱剩余 标准碱剩余 乳酸 乳酸脱氢酶 急性生理与慢性健康状况评分Ⅱ 序贯器官衰竭评分 

分 类 号：R459.7[医药卫生—急诊医学]