成人体外心肺复苏临床特征及死亡风险因素——单中心经验  

Clinical characteristics and risk factors for mortality in adult extracorporeal cardiopulmonary resuscitation:a single-center experience

作　　者：靖颖霞[1] 尹礼义 黄明君[2] 胡聪龙 徐宝珠 曹彦[1] JING Yingxia;YIN Liyi;HUANG Mingjun;HU Conglong;XU Baozhu;CAO Yan(Department of Emergency Medicine,Hunan Provincial People's Hospital,the First Affiliated Hospital of Hunan Normal University,Changsha,410016,China;Department of Extracorporeal Support Center, the First Affiliated Hospital of Zhengzhou University;Department of Emergency Medicine, the People's Hospital of Hebi)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)急诊医学科,长沙410016 [2]郑州大学第一附属医院体外支持中心 [3]鹤壁市人民医院急诊科

出　　处：《临床急诊杂志》2024年第11期586-591,共6页Journal of Clinical Emergency

摘　　要：目的:探讨成人体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)的临床特征及死亡风险因素,为此临床技术提供参考。方法:经过严格纳排标准后,选取2022年1月—2023年10月经郑州大学第一附属医院使用ECPR技术辅助治疗的111例难治性心脏骤停患者,采取回顾性分析方法,将临床结局分为存活组(47例,42.3%)和死亡组(64例,57.7%),对其临床特征及风险因素进行分析。结果:心脏骤停场所主要在重症监护室(38例,34.2%),且不同心脏骤停场所组间比较差异有统计学意义(P=0.020)。不同角色的心脏骤停目击者在临床结局中比较差异有统计学意义(P=0.026)。死亡组的APACHEⅡ评分高于存活组,差异有统计学意义(P=0.006)。死亡组在ECMO运行时间(P=0.013)、ICU时长(P<0.001)及住院时长(P<0.001)均少于存活组,差异有统计学意义。死亡组在神经系统并发症(P<0.001)、CRRT使用(P=0.002)、肢体并发症(P=0.025)及心脏并发症(P<0.001)发生率均高于存活组,差异有统计学意义。死亡组与存活组相比,肢体并发症增加了3.9倍,而心脏并发症增加了6.8倍。结论:ECPR患者的选择应基于心脏骤停场所、是否有目击者、目击者是否CPR、无血流和低血流状态的持续时间以及是否存在可逆病因等因素。防治ECPR并发症如肢体并发症和心脏并发症,可能改善患者的预后。Objective:To investigate the clinical characteristics and mortality risk factors of adult extracorporeal cardiopulmonary resuscitation(ECPR) to provide a reference for this clinical technique.Methods:A total of 111 patients with refractory cardiac arrest who received ECPR assistance at the First Affiliated Hospital of Zhengzhou University from January 2022 to October 2023 were selected based on strict inclu-sion and exclusion criteria.A retrospective analysis was conducted,dividing the clinical outcomes into survival and non-survival groups to analyze their clinical characteristics and risk factors.Results:The survival group consisted of 47 cases(42.3%),and the non-survival group consisted of 64 cases(57.7%).Cardiac arrest mainly occurred in the intensive care unit(38 cases,34.2%),with a statistically significant difference between different cardiac arrest locations(P=0.020).Different roles of cardiac arrest witnesses also showed a statistical difference in clinical outcomes(P=0.026).The APACHE Ⅱ scores of the non-survival group were higher than those of the survival group(P=0.006).The non-survival group had shorter ECMO running time(P=0.013),ICU stay(P<0.001),and hospital stay(P<0.001) compared to the survival group.The incidence rates of neurological complications(P<0.001),CRRT use(P=0.002),limb complications(P=0.025),and cardiac complications(P<0.001) were higher in the non-survival group than in the survival group.Limb complications increased by 3.9 times,and cardiac complications increased by 6.8 times in the non-survival group compared to the survival group.Conclusion:The selection of ECPR patients should be based on factors such as the location of cardiac arrest,the presence of witnesses,whether CPR was performed by witnesses,the duration of no-flow and low-flow states,and the presence of reversible causes.Preventing and managing ECPR complications such as limb and cardiac complications may improve patient outcomes.

关 键 词：成人 体外心肺复苏 临床特征 风险因素 

分 类 号：R541.7[医药卫生—心血管疾病]