动脉血二氧化碳分压及血乳酸与体外膜肺氧合患者消化道出血的关联性研究  

A study on the correlation of arterial partial pressure of carbon dioxide and blood lactic acid with gastrointestinal bleeding in patients undergoing extracorporeal membrane oxygenation

作　　者：朱良峰[1] 沈印[1] 陈万[1] 吕立文[1] ZHU Liangfeng;SHEN Yin;CHEN Wan;LYU Liwen(International Medical Services,the People′s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences),Nanning 530021,China)

机构地区：[1]广西壮族自治区人民医院(广西医学科学院)国际医疗部,南宁530021

出　　处：《中国临床新医学》2025年第2期184-188,共5页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：广西重点研发计划项目(编号:桂科AB23026019);广西医疗卫生适宜技术开发与推广应用项目(编号:S2020080)。

摘　　要：目的探讨动脉血二氧化碳分压及血乳酸与体外膜肺氧合(ECMO)患者消化道出血的关联性。方法回顾性收集2020年1月至2022年12月在广西壮族自治区人民医院急诊监护病房住院并行静脉-静脉体外膜肺氧合(VV-ECMO)或静脉-动脉体外膜肺氧合(VA-ECMO)治疗的94例患者的临床资料。根据患者ECMO治疗期间是否发生消化道出血分为出血组(21例)和非出血组(73例)。比较两组动脉血二氧化碳分压、血乳酸等临床资料。采用二元logistic回归分析ECMO患者消化道出血的危险因素。通过受试者工作特征(ROC)曲线分析相关指标对消化道出血的预测效能。结果ECMO治疗前,两组血管活性-正性肌力药物评分(VIS)、平均动脉压(MAP)、血乳酸、动脉血二氧化碳分压比较差异无统计学意义(P>0.05)。ECMO治疗后24 h,两组VIS、血乳酸、动脉血二氧化碳分压低于治疗前,MAP高于治疗前,且非出血组血乳酸、动脉血二氧化碳分压低于出血组,差异有统计学意义(P<0.05)。二元logistic回归分析结果显示,ECMO治疗后24 h动脉血二氧化碳分压和血乳酸是ECMO患者发生消化道出血的独立危险因素(P<0.05)。ROC曲线分析结果显示,ECMO治疗后24 h动脉血二氧化碳分压和血乳酸均能有效预测消化道出血的发生(P<0.05),两项指标联合可进一步提高预测效能[AUC(95%CI)=0.752(0.614~0.890),P<0.05],灵敏度、特异度分别为71.43%、79.45%。结论ECMO治疗后24 h动脉血二氧化碳分压和血乳酸可作为ECMO治疗期间患者发生消化道出血的早期预测指标,对于降低ECMO治疗期间患者消化道出血发生率,提高生存率具有重要临床意义。Objective To explore the correlation of arterial partial pressure of carbon dioxide and blood lactic acid with gastrointestinal bleeding in patients undergoing extracorporeal membrane oxygenation(ECMO).Methods The clinical data of 94 patients who were admitted to the Emergency Intensive Care Unit of the People′s Hospital of Guangxi Zhuang Autonomous Region for treatment of veno-venous extracorporeal membrane oxygenation(VV-ECMO)or venous-arterial extracorporeal membrane oxygenation(VA-ECMO)from January 2020 to December 2022 were retrospectively collected.The patients were divided into bleeding group(21 cases)and non-bleeding group(73 cases)based on whether they experienced gastrointestinal bleeding during the period of ECMO treatment.The clinical data of arterial partial pressure of carbon dioxide and blood lactic acid were compared between the two groups.The risk factors of gastrointestinal bleeding in the patients undergoing ECMO were analyzed by using binary logistic regression.The predictive efficiency of the relevant indicators for gastrointestinal bleeding was analyzed by using receiver operating characteristic(ROC)curves.Results Before the treatment of ECMO,there were no significant differences in vasoactive-inotropic score(VIS),mean arterial pressure(MAP),blood lactic acid and arterial partial pressure of carbon dioxide between the two groups(P>0.05).After the treatment of ECMO for 24 hours,VIS,blood lactic acid and arterial partial pressure of carbon dioxide in both groups were lower than those before treatment,and the values of MAP in both groups after the treatment of ECMO for 24 hours were higher than those before treatment,and blood lactic acid and arterial partial pressure of carbon dioxide in the non-bleeding group were lower than those in the bleeding group,and the differences were statistically significant(P<0.05).The results of binary logistic regression analysis showed that arterial partial pressure of carbon dioxide and blood lactic acid 24 hours after the treatment of ECMO were independent

关 键 词：体外膜肺氧合 动脉血二氧化碳分压 血乳酸 消化道出血 预测 

分 类 号：R459.7[医药卫生—急诊医学]