体外膜肺氧合支持治疗成人患者发生急性脑损伤的影响因素  

Influencing factors of acute brain injury in adult extracorporeal membrane oxygenation patients

作　　者：黄明君[1] 赵高峰[2] 尹礼义 李军[1] HUANG Mingjun;ZHAO Gaofeng;YIN Liyi;LI Jun(Department of Extracorporeal Support Center,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Lung Transplantation,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Emergency Medicine,Hunan Provincial People's Hospital,the First Affiliated Hospital of Hunan Normal University,Changsha,Hunan 410000,China)

机构地区：[1]郑州大学第一附属医院体外支持中心,河南郑州450052 [2]郑州大学第一附属医院肺移植科,河南郑州450052 [3]湖南省人民医院湖南师范大学附属第一医院急诊医学科,湖南长沙410000

出　　处：《中华实用诊断与治疗杂志》2024年第11期1122-1126,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：郑州市科技协同创新专项项目(XTCX2023009)。

摘　　要：目的观察行体外膜肺氧合(ECMO)支持治疗的成人患者急性脑损伤(ABI)发生情况,探讨ABI发生的影响因素。方法2019年1月—2023年1月郑州大学第一附属医院行ECMO支持治疗的成人患者584例,ECMO期间发生ABI者为ABI组,未发生ABI者为无ABI组。比较2组性别、年龄、体质量指数、合并症、吸烟史、饮酒史、ECMO上机前心脏骤停比率、ECMO上机适应证、ECMO支持时间、ICU停留时间、住院时间、上机前血压、ECMO相关并发症以及上机4、24 h时乳酸、pa(CO_(2))、CO_(2)清除率;采用多因素logistic回归分析ECMO支持治疗的成人患者发生ABI的影响因素。结果(1)ECMO期间118例(20.2%)发生ABI,其中缺血性卒中13例,脑出血23例,缺氧缺血性脑损伤64例,脑水肿7例,癫痫发作11例。(2)ABI组ECMO上机前心脏骤停(41.0%)、体外心肺复苏上机(18.6%)比率均高于无ABI组(16.5%、6.4%)(χ^(2)=33.330,P<0.001;χ^(2)=8.932,P=0.003),ICU停留时间[9(4,17)d]、住院时间[15(7,26)d]均短于无ABI组[14(9,22)、26(14,41)d](U=34367.000,P<0.001;U=35336.000,P<0.001),上机4、24 h时血乳酸[7.3(3.3,15.0)、3.5(1.9,7.5)mmol/L]均高于无ABI组[3.0(1.6,7.0)、2.1(1.3,3.2)mmol/L](U=12793.000,P<0.001;U=15186.000,P<0.001),上机24 h时CO_(2)清除率[0.174%(0.123%,0.240%)]高于无ABI组[0.161%(0.112%,0.227%)](χ^(2)=11.170,P=0.040),出血(66.9%)、高胆红素血症(63.6%)、急性肾功能衰竭(50.0%)、继发感染(55.1%)发生率均高于非ABI组(41.2%、48.9%、28.8%、34.5%)(χ^(2)=10.170~26.040,P均<0.05),性别比例、年龄、体质量指数、合并症、吸烟史、饮酒史、ECMO支持时间等其余指标与无ABI组比较差异均无统计学意义(P>0.05)。(3)ECMO上机前心脏骤停(OR=6.130,95%CI:1.063~17.660,P<0.001)、体外心肺复苏上机(OR=8.027,95%CI:1.473~24.767,P=0.001)、上机4 h时血乳酸(OR=3.178,95%CI:1.061~15.230,P<0.001)、上机24 h时血乳酸(OR=8.166,95%CI:1.061~13.667,P<0.001)、上机24 h时CO_(2)清除率(OR=4.123,95%CI:1.601~11.566Objective To observe the occurrence of acute brain injury(ABI)in adult patients receiving extracorporeal membrane oxygenation(ECMO)support and to explore the influencing factors of ABI.Methods Totally 584 adult patients received ECMO support in the First Affiliated Hospital of Zhengzhou University from January 2019 to January2023,and were divided into ABI group and non-ABI group according to the occurrence of ABI during ECMO support.The gender,age,body mass index,comorbidities,smoking history,alcohol consumption history,pre-ECMO cardiac arrest rate,ECMO indications,duration of ECMO support,length of ICU stay,length of hospital stay,pre-ECMO blood pressure,ECMO-related complications,and lactate,pa(CO_(2))and CO_(2) clearance rate 4 and 24 h after ECMO were compared between two groups.Multivariate logistic regression analysis was done to assess the influencing factors of ABI during ECMO support.Results(1)ABI developed in 118 patients(20.2%)during ECMO support,including 13 cases of ischemic stroke,23 of intracranial hemorrhage,64 of hypoxic-ischemic brain injury,7 of cerebral edema,and 11 of seizures.(2)The rates of pre-ECMO cardiac arrest and extracorporeal cardiopulmonary resuscitation(ECPR)used were significantly higher in ABI group(41.0%,18.6%)than those in non-ABI group(16.5%,6.4%)(χ^(2)=33.330,P<0.001;χ^(2)=8.932,P=0.003).The length of ICU stay and length of hospital stay were shorter in ABI group[9(4,17),15(7,26)d]than those in non-ABI group[14(9,22),26(14,41)d](U=34367.000,P<0.001;U=35336.000,P<0.001),The lactate levels 4 and 24 h after ECMO were higher in ABI group[7.3(3.3,15,0),3.5(1.9,7.5)mmol/L]than those in non-ABI group[3.0(1.6,7.0),2.1(1.3,3.2)mmol/L](U=12793.000,P<0.001;U=15186.000,P<0.001).The CO_(2) clearance rate 24 h after ECMO was higher in ABI group[0.174%(0.123%,0.240%)]than that in non-ABI group[0.161%(0.112%,0.227%)][χ^(2)=11.170,P=0.040),The incidence of bleeding,hyperbilirubinemia,acute renal failure,and secondary infections were significantly higher in ABI group(66.9%,63.6%,50.0%,55.1%

关 键 词：急性脑损伤 体外膜肺氧合 影响因素 

分 类 号：R651.15[医药卫生—外科学]