静脉—动脉体外膜氧合辅助患者胃肠功能障碍的危险因素分析  

Analysis of risk factors for gastrointestinal dysfunction in patients assisted with venous arterial extracorporeal membrane oxygenation

作　　者：柏勇 黄光庆[2] 赵旭 史君星 柳云恩 Bai Yong;Huang Guangqing;Zhao Xu;Shi Junxing;Liu Yunen(Graduate School of Shenyang Medical College,Liaoning Shenyang 110034,China)

机构地区：[1]沈阳医学院研究生院,沈阳110034 [2]湖北省十堰市人民医院重症医学科,十堰442000 [3]沈阳医学院树人国际学院,沈阳110034

出　　处：《中国体外循环杂志》2024年第1期4-7,12,共5页Chinese Journal of Extracorporeal Circulation

基　　金：2022年沈阳市科技计划自然科学基金专项项目(22-315-6-17)。

摘　　要：目的 研究分析静脉-动脉体外膜氧合(V-A ECMO)辅助患者发生胃肠功能障碍的危险因素和对其预后的影响。方法 回顾性分析2019年1月至2023年7月湖北省十堰市人民医院重症医学科成功撤机的V-A ECMO辅助患者52例,按照是否出现胃肠功能障碍分为胃肠功能障碍组和非胃肠功能障碍组,其中胃肠功能障碍组29例,非胃肠功能障碍23例,通过组间单因素分析筛选出胃肠功能障碍的危险因素,经logistic回归分析确定影响胃肠功能障碍的危险因素。结果 经过单因素分析表明较低V-A ECMO辅助流量、高血乳酸、较短时间主动脉球囊反搏(IABP)及ECMO辅助、较晚启动肠内营养、较大剂量去甲肾上腺素使用量为胃肠功能障碍的危险因素,通过多元logistic回归分析表明较短时间IABP辅助及相对较晚启动肠内营养为胃肠功能障碍的独立危险因素。结论 V-A ECMO辅助期间,较短时间IABP辅助及相对较晚启动肠内营养为其发生胃肠功能障碍的独立危险因素。Objective To analyze the risk factors for gastrointestinal dysfunction and their impact on prognosis in patients supported with venous arterial extracorporeal membrane oxygenation(V-A ECMO).Method A retrospective analysis was conducted on 52 patients who successfully weaned from ECMO in the Intensive Care Department of Shiyan People's Hospital in Hubei Province from January 2019 to July 2023.They were divided into gastrointestinal dysfunction group(n = 29)and non-gastrointestinal dysfunction group(n = 23).The risk factors for gastrointestinal dysfunction were screened through inter group univariate analysis,and the risk factors affecting gastrointestinal dysfunction were determined through logistic regression analysis.Result Univariate analysis showed that lower V-A ECMO flow,high blood lactate,shorter duration of aortic balloon counterpulsation(IABP) and ECMO,later initiation of enteral nutrition,and higher dose of norepinephrine were risk factors for gastrointestinal dysfunction.Multivariate logistic regression analysis showed that shorter duration of IABP and relatively late initiation of enteral nutrition were independent risk factors for gastrointestinal dysfunction.Conclusion During V-A ECMO assistance,shorter duration of IABP assistance and relatively late initiation of enteral nutrition are independent risk factors for gastrointestinal dysfunction.

关 键 词：体外膜氧合 胃肠功能障碍 危险因素 肠内营养 

分 类 号：R57[医药卫生—消化系统]