静脉-动脉体外膜肺氧合治疗患者合并毛细血管渗漏综合征分布状态、危险因素及预后  

To explore the distribution,risk factors and prognosis of capillary leakage syndrome in VA⁃ECMO pa⁃tients

作　　者：何罗宜 刘品晶[1] 黄静铭[1] 古立新[1] 汤展宏[2] HE Luoyi;LIU Pinjing;HUANG Jingming;GU Lixin;TANG Zhanhong(Department of Critical Care,Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine,Guangxi Hospital of Integrated Traditional Chinese and Western Medicine,Nanning 530001,Guangxi,China;不详)

机构地区：[1]广西中医药大学附属瑞康医院(广西壮族自治区中西医结合医院)重症医学科,广西南宁530001 [2]广西医科大学第一附属医院重症医学科,广西南宁530022

出　　处：《实用医学杂志》2025年第4期542-546,共5页The Journal of Practical Medicine

基　　金：国家自然科学基金项目(编号:81660313);广西卫健委科研项目(编号:Z-A20230928)。

摘　　要：目的了解静脉-动脉体外膜肺氧合(VA-ECMO)治疗患者合并毛细血管渗漏综合征(CLS)分布状态、危险因素及预后。方法收集2019年12月至2023年12月广西中医药大学附属瑞康医院急诊科、ICU 1区、ICU 2区115例VA-ECMO患者进行前瞻性临床观察研究,观察此类患者是否合并CLS及其VA-ECMO运行时间及状态;同时记录各患者疾病类型、血气分析pH值、HCO3-浓度、乳酸值(LAC)、血清白蛋白等。各因素对VA-ECMO并CLS之影响采用二元logistic回归,计量资料应用t检验,计数资料应用χ^(2)检验。结果总体VA-ECMO患者发生CLS为61例,占比高达53.04%。脓毒症、ECPR、pH值、LAC值为VA-ECMO并CLS危险因素(P<0.05)。CLS组ECMO 24 h运行失败率高达49.18%,高于非CLS组(P<0.001)。CLS组ECMO运行时间均值为39.53 h,低于非CLS组(t=2.318,P<0.05)。CLS组死亡率高达88.24%,高于非CLS组(57.69%)(χ^(2)=14.18,P<0.001)。结论VA-ECMO合并CLS比例并不低,脓毒症、ECPR、pH值、LAC为VA-ECMO并CLS危险因素,VA-ECMO合并CLS严重影响ECMO运行。对于VA-ECMO患者,应高度关注毛细血管渗漏状态及其危险因素,早期处理潜在病因,促使ECMO顺利进行,进而改善其预后。Objective To investigate the distribution,risk factors and prognosis of VA-ECMO patients with capillary leakage syndrome(CLS).Methods 115 cases of VA-ECMO were collected in Emergency department,ICU 1 and 2 of Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine from December 2019 to December 2023 for prospective clinical observation study.It was observed the operation time and status of VA-ECMO and whether VA-ECMO patients were complicated with CLS.At the same time,type of disease,blood gas pH,HCO3-concentration,lactate value(LAC),serum albumin and so on were recorded.The influence of various factors on VA-ECMO with CLS was analyzed by binary Logistic regression.T test was used for measurement data andχ^(2) test was used for counting data.Results Capillary leakage syndrome in VA-ECMO patients were 61 cases,which had accounted for 53.04%.Sepsis,ECPR,pH value and LAC were the risk factors for VA-ECMO with CLS(P<0.05).The operation failure rate of ECMO in 24 hours of CLS group was 49.18%higher than that of non-CLS group(P<0.001).The mean running time of ECMO in CLS group was 39.53 hours,which was lower than that of non-CLS group(t=2.318,P<0.05).The mortality rate of CLS group was 88.24%,higher than that of non-CLS group(57.69%)(χ^(2)=14.18,P<0.001).Conclusions The proportion of VA-ECMO combined with CLS was not low.Sepsis,ECPR,pH value and LAC were risk factors for VA-ECMO with CLS,and VA-ECMO combined with CLS seriously affected the operation of ECMO.For patients with VA-ECMO,it should be paid more attention to observe whether they have capillary leakage and its risk factors,and the potential etiology should be treated early to promote the progress of ECMO and improve their prognosis.

关 键 词：静脉-动脉体外膜肺氧合 毛细血管渗漏综合征 体外心肺复苏 脓毒症 

分 类 号：R459.7[医药卫生—急诊医学]