早期CRRT联合VA-ECMO治疗难治性心源性休克的临床效果  

Clinical Effects of Early CRRT Combined with VA-ECMO in the Treatment of Refractory Cardiogenic Shock

作　　者：詹维强 李梦蝶 涂玉玲 郭艳 芦乙滨 史新格 许明 Zhan Weiqiang;Li Mengdie;Tu Yulin;Guo Yan;Lu Yibin;Shi Xinge;Xu Ming(Department of Intensive Care Medicine,Xinyang Central Hospital,Xinyang 464000,China)

机构地区：[1]信阳市中心医院重症医学科,河南信阳464000

出　　处：《中华卫生应急电子杂志》2024年第5期260-268,共9页Chinese Journal of Hygiene Rescue(Electronic Edition)

基　　金：信阳市创新专项项目(20210017)。

摘　　要：目的本研究旨在探讨早期连续性肾替代治疗(CRRT)联合静脉-动脉体外膜氧合(VA-ECMO)在难治性心源性休克患者中的应用效果及其对患者预后的影响。方法采用前瞻性随机对照研究,分析信阳市中心医院ICU病房2021年1月至2023年10月期间接受VA-ECMO治疗的难治性心源性休克患者74例,其中男性49例,女性25例;年龄19~78岁,平均(56.3±14.0)岁。随机分为早期CRRT组(A组)和常规CRRT组(B组),比较两组患者的T0(VA-ECMO上机前)、T3(VA-ECMO上机后3 d)、T5(VA-ECMO上机后5 d)、T7(VA-ECMO上机后7 d)不同时间点的血常规、肝肾功能、血气分析、心功能指标和治疗结果。结果共纳入患者74例(A组35例,B组39例),两组患者在基线资料差异无统计学意义。A组与B组在治疗时间方面差异均有统计学意义,分别为:CRRT治疗时间[176.1(152.2~222.9)h比82.3(0~103.9)h,P<0.001],机械通气时间[(309.3±38.5)h比(331.7±43.6)h,P=0.023],VA-ECMO支持时间[237.0(220.0~255.5)h比253.0(236.5~265.0)h,P=0.029]。两组患者的ICU住院时间和并发症发生率分别为:[(16.3±3.0)d比(17.8±3.8)d,P=0.052],[60.00%(21)例比71.79%(28)例,P=0.284],差异无统计学意义,A组病死率低于B组:[15例(42.86%)比26例(66.67%),P=0.040]。两组血红蛋白计数(Hb)仅在T3时间点差异有统计学意义[(106.1±18.7)g/L比(114.7±19.6)g/L,P=0.018]。C反应蛋白(CRP)在T3和T5时间点存在差异,分别为[73.0(39.5~115.5)mg/L比97.0(62.5~158.5)mg/L,P=0.021],[82.0(59.5~126.5)mg/L比120.0(47.5~175.0)mg/L,P=0.028]。IL-6水平:在T3和T5时间点存在差异,分别为[344.0(153.0~740.5)pg/mL比667.0(342.0~1484.0)pg/mL,P=0.038],[270.0(108.0~556.0)pg/mL比721.0(401.0~1195.5)pg/mL,P=0.001]。血尿素氮(BUN)在T3、T5、T7时间点分别为[6.7(6.0~10.3)mmol/L比21.9(13.5~29.2)mmol/L,P<0.001],[6.8(5.4~10.0)mmol/L比27.8(17.6~37.8)mmol/L,P<0.001],[6.0(4.5~10.7)mmol/L比31.0(24.4~34.7)mmol/L,P<0.001];血肌酐(Cr)水平在T3、T5、T7时间点分别为[94.3(80.0~124.5)μmol/L比257.0Objective To explore the effects of early continuous renal replacement therapy(CRRT)combined with veno-arterial extracorporeal membrane oxygenation(VA-ECMO)on patients with refractory cardiogenic shock and its impact on their prognosis.Methods A prospective randomized controlled trial was conducted to analyze 74 patients with refractory cardiogenic shock who received VA-ECMO treatment in the ICU of Xinyang Central Hospital from January 2021 to October 2023.The cohort consisted of 49 males and 25 females,aged between 19 and 78 years,with an average age of 56.3±14.0 years.Patients were randomly assigned to either the early CRRT group(Group A,35 patients)or the conventional CRRT group(Group B,39 patients).The study compared various clinical parameters,including blood tests,liver and kidney function,blood gas analysis,cardiac function indicators,and treatment outcomes at four time points:T0(pre-VA-ECMO),T3(3 days post-VA-ECMO),T5(5 days post-VA-ECMO),and T7(7 days post-VAECMO).Results A total of 74 patients were enrolled(35 in Group A and 39 in Group B).No significant differences were observed between the two groups in baseline characteristics.However,significant differences were found in the treatment duration between the groups,including CRRT treatment time[176.1(152.2-222.9)hours vs.82.3(0-103.9)hours,P<0.001],mechanical ventilation time[(309.3±38.5)hours vs(331.7±43.6)hours,P=0.023],and VA-ECMO support time[237.0(220.0-255.5)hours vs.253.0(236.5-265.0)hours,P=0.029].ICU stay and complication incidence rates were not statistically different between the groups[(16.3±3.0)days vs.(17.8±3.8)days,P=0.052],[60%vs 71.79%,P=0.284],respectively.However,the mortality rate was significantly lower in Group A[15(42.86%)vs.26(66.67%),P=0.040].Hemoglobin(Hb)values at T3 showed a statistical difference[(106.1±18.7)g/L vs(114.7±19.6)g/L,P=0.018].C-reactive protein(CRP)values at T3 and T5 were different[73.0(39.5-115.5)mg/L vs.97.0(62.5-158.5)mg/L,P=0.021],[82.0(59.5-126.5)mg/L vs.120.0(47.5-175.0)mg/L,P=0.028].Interleukin-6

关 键 词：连续性肾替代治疗 体外膜氧合 难治性心源性休克 

分 类 号：R47[医药卫生—护理学]