血液吸附对非体外冠状动脉移植术后体外膜氧合患者全身炎症反应的影响  

Effect of hemoperfusion on systemic inflammatory response in patients with V-A extracorporeal membrane oxygenation after off-pump coronary artery bypass grafting

作　　者：韩丹诺 张帅 王红[1] 贾明[1] 侯晓彤[1] 杜中涛[1] HAN Dannuo;ZHANG Shuai;WANG Hong;JIA Ming;HOU Xiaotong;DU Zhongtao(Department of Intensive Care Unit of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

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

出　　处：《心肺血管病杂志》2024年第8期846-853,共8页Journal of Cardiovascular and Pulmonary Diseases

基　　金：“首发”重点攻关项目:急性心梗心源性休克救治体系现状调查和救治规范制定(首发2024-1-1051);北京市临床重点专科建设项目(重症医学);北京市高层次公共卫生技术人才建设项目;国家重点研发计划(2021YFC2701703);ECLSA2022吸附型体外生命支持技术(No.BHCF20220207)。

摘　　要：目的:探讨炎症因子及全身炎症反应评分在非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)后体外膜氧合(extracorporeal membrane oxygenation,ECMO)患者中的变化规律以及血液吸附(hemoperfusion,HP)的影响。方法:2019年1月至2022年12月,首都医科大学附属北京安贞医院心脏外科重症监护室OPCABG术后进行V-A ECMO辅助的患者42例,分为ECMO组(n=24),ECMO+HP组(n=18)。ECMO组常规辅助;ECMO+HP组为ECMO辅助24h内,联合应用灌流器总治疗时长18h。收集两组患者V-A ECMO开始24h内或血液吸附开始0、6、12、18h、结束后24及48h的炎症因子水平和全身炎症反应评分(systemic inflammatory response syndrome, SIRS);实验室及临床预后相关资料。结果:CRP、IL-6、IL-8、TNF-α和IL-1β的变化率,在ECMO+HP组随时间推移持续下降,且与ECMO组比较,均差异有统计学意义。ECMO+HP组的LAC和全身炎症反应评分明显下降;感染率明显降低(5.6%vs. 33.3%,P=0.030);ECMO辅助时间显著缩短[(132.0±20.1)vs.(155.9±24.2) h,P=0.001],撤机率明显提高(83.3%vs. 41.7%,P=0.001),撤机后24h序贯器官衰竭(sequential organ failure assessment,SOFA)评分[8.0(7.0,9.0) vs. 8.0 (7.8,9.0),P=0.038]和血管活性药物评分(vasoactive-inotropic score,VIS)[8.0(7.0,9.0) vs. 9.0(8.0,10.0),P=0.003]显著低于ECMO组。结论:OPCABG术后VA-ECMO期间,应用血液吸附可能与降低炎症反应和并发症的减少有关,但在ICU住院时间和死亡率方面无明显差异。Objective:To investigate the changes of inflammatory factors and systemic inflammatory response scores in patients with extracorporeal membrane oxygenation(ECMO)after off-pump coronary artery bypass grafting(OPCABG)and the influence of hemoperfusionn(HP).Methods:The 42 cases of patients who underwent V-A ECMO after OPCABG in the Center for Cardiac Intensive Care,Beijing Anzhen Hospital,from January 2019 to December 2022,were divided into ECMO group(n=24)and ECMO+HP group(n=18).ECMO group was treated by protocol;In the ECMO+HP group,HP time was 18 hours.The observations and HP treatment were started within 24 hours of ECMO catheterization.The general information,levels of inflammatory factors,inflammatory response scores at 0,6,12,18,24,48h,clinical prognostic data were collected.Results:The change rates of CRP,IL-6,IL-8,TNF-αand IL-1βin the ECMO+HP group decreased continuously over time.There were significant differences compared with the ECMO group.LAC,SIRS score and infection rate(5.6%vs.33.3%,P=0.030)was significantly decreased in the ECMO+HP group.The duration time of ECMO was significantly shortened[(132.0±20.1)vs.(155.9±24.2)h,P=0.001],and the rate of weaning off ECMO was significantly increased(83.3%vs.41.7%,P=0.001).Sequential organ failure assessment(SOFA)score[8.0(7.0,9.0)vs.8.0(7.8,9.0),P=0.038]and vasoactive-inotropic score(VIS)[8.0(7.0,9.0)vs.9.0(8.0,10.0),P=0.003]were significantly lower than ECMO group.Conclusions:Hemoperfusion might be associated with the reduction of inflammation and complications in VA-ECMO after OPCABG,but there were no significant differences in length of ICU stay and mortality.

关 键 词：血液吸附 体外膜氧合 非体外循环冠状动脉旁路移植术 炎症因子 全身炎症反应评分 

分 类 号：R54[医药卫生—心血管疾病]