心脏外科术后患者VA-ECMO辅助的临床结局及早期死亡危险因素分析  

Analysis of clinical outcome and early death risk factors of patients after cardiac surgery assisted by VA-ECMO

作　　者：赵帅 吴锐 刘志刚[2] Zhao Shuai;Wu Rui;Liu Zhigang(Department of Thoracic Surgery,Tianjin Chest Hospital,Tianjin 300222,China;不详)

机构地区：[1]天津市胸科医院胸外科,天津300222 [2]天津大学泰达国际心血管病医院心脏外科,天津300457

出　　处：《中国循证心血管医学杂志》2025年第1期94-98,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：天津市科技计划项目(21JCYBJC00480)。

摘　　要：目的总结心脏外科术后患者使用静脉-动脉ECMO(VA-ECMO)支持治疗的早期临床结局,分析影响患者早期死亡的危险因素。方法收集2018年1月至2021年12月期间于泰达国际心血管病医院心脏外科术后接受VA-ECMO支持的44例患者临床资料,分析心脏术后患者VA-ECMO支持的早期结局及早期死亡的危险因素。结果44例外科术后患者使用ECMO辅助,平均年龄63.45±11.25岁,其中男性28例(63.6%),脱机24例(54.5%),存活16例,总体生存率36.4%。主要诊断为冠状动脉粥样硬化性心脏病(冠心病)、心脏瓣膜病。存活组与死亡组的ECMO辅助时间分别为189.50 h(113.00,248.50)和121.50 h(38.50,240.50),差异有统计学意义(P=0.00)。存活组的ICU时间和住院时间高于死亡组(P<0.05),两组在性别、体重、合并症、手术方式、体外循环时间及主动脉阻断时间、上机时血流动力学方面,无明显差异(P>0.05);在年龄、射血分数(EF)、左室舒张末期容积(LVEDV)、肌酐(Cr)、撤机时血流动力学、撤机时乳酸(Lac)均有统计学意义(P<0.05)。多因素分析结果显示术前肾功能不全,左室射血分数(LVEF)及Cr、主动脉内球囊反搏泵(IABP),是影响辅助结局的独立危险因素。结论VA-ECMO辅助心脏外科术后重症患者显示出较好的效果。术前肾功能、EF、Cr,是否联合IABP,均是影响成人心脏外科患者围术期辅助结局的独立因素。Objective To summarize the early clinical outcome of veno-arterial ECMO(VA-ECMO)in patients after cardiac surgery,and analyze the risk factors of early death.Method The clinical data of 44 patients who received VA-ECMO support after cardiac surgery in TEDA International Cardiovascular Hospital from January 2018 to December 2021 were collected,and the early outcome of VA-ECMO support and the risk factors of early death were analyzed.Result Forty-four patients were assisted by ECMO after surgery,with an average age of 63.45±11.25 years,including 28 males(63.6%)and 24 offline patients(54.5%).Sixteen patients survived,with an overall survival rate of 36.4%.The main diagnosis is coronary atherosclerotic heart disease(coronary heart disease)and valvular heart disease.The ECMO assisting time in the survival group and the death group was 189.50 h(113.00,248.50)and 121.50 h(38.50,240.50)respectively,with statistical significance(P=0.00).The ICU time and hospitalization time in the survival group were longer than those in the death group(P<0.05),and there was no significant difference between the two groups in terms of gender,weight,complications,operation mode,cardiopulmonary bypass time,aortic occlusion time and hemodynamics during boarding(P>0.05).There were significant differences in age,ejection fraction(EF),left ventricular end diastolic volume(LVEDV),creatinine(Cr),hemodynamics during weaning and lactic acid(Lac)during weaning(P<0.05).Multivariate analysis showed that preoperative renal insufficiency,left ventricular ejection fraction(LVEF),Cr,intra-aortic balloon pump(IABP)were independent risk factors affecting the assisted outcome.Conclusion VA-ECMO is effective in assisting critically ill patients after cardiac surgery.Preoperative renal function,EF,Cr and whether IABP is combined or not are independent factors that affect the perioperative auxiliary outcome of adult cardiac surgery patients.

关 键 词：体外膜肺氧合 心脏外科 临床结局 危险因素 

分 类 号：R541[医药卫生—心血管疾病]