静脉-动脉体外膜肺氧合患者预后影响因素分析  

Analysis of prognostic factors and nursing strategy of veno-arterial extracorporeal membrane oxygenation

作　　者：陈吉润 钱进 彭伟 陈琨 Chen Jirun;Qian Jin;Peng Wei;Chen Kun(Department of Intensive Care Medicine,Affiliated Jinhua Hospital Zhejiang University School of Medicine,Jinhua 321000,Zhejiang,China)

机构地区：[1]浙江大学医学院附属金华医院重症医学科,浙江金华321000

出　　处：《中国中西医结合急救杂志》2024年第6期670-675,共6页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家卫健委科研基金—浙江省医药卫生重大科技计划(WKJ-ZJ-2303);浙江省金华市科技局社会发展类重大项目(2022-3-060)。

摘　　要：目的探讨影响静脉-动脉体外膜肺氧合(VA-ECMO)患者预后的因素。方法回顾性分析2019年1月至2022年10月收住浙江大学医学院附属金华医院的VA-ECMO患者的临床资料,收集患者的人口学特征、既往疾病、体外膜肺氧合(ECMO)建立时的临床资料,如是否胸外按压心肺复苏、是否院外转运、是否行介入手术、VA-ECMO治疗期间是否出血、是否联合连续性肾脏替代治疗(CRRT)、是否成功撤机,以及ECMO建立后24、48、72 h白蛋白(ALB)、降钙素原(PCT)、血乳酸(Lac)、血红蛋白(Hb)、血小板计数(PLT)等指标,统计ECMO支持时间、重症监护病房(ICU)住院时间及总住院时间。将患者按预后分为存活组与死亡组,比较不同预后两组上述临床指标差异。将单因素分析差异有统计学意义的指标纳入多因素COX回归分析筛选出影响VA-ECMO患者预后的危险因素,并绘制受试者工作特征曲线(ROC曲线)分析各危险因素对患者预后的预测价值。结果共纳入56例患者,其中存活组37例,死亡组19例,ECMO支持模式均为VA-ECMO。与存活组比较,死亡组联合CRRT比例和24、48、72 h、48 h与72 h PCT差值及48 h、72 h Lac水平均明显升高〔联合CRRT比例:78.9%(15/19)比35.1%(13/37),PCT(μg/L):24 h为26.89(9.51,69.42)比3.96(1.83,19.23),48 h为32.67(11.37,49.84)比4.27(1.08,15.51),72 h为24.86(7.73,34.80)比2.03(0.62,9.20),48 h与72 h差值为-7.91(-14.91,-2.50)比-0.85(-6.17,-0.24);Lac(mmol/L):48 h为2.50(1.54,5.70)比1.60(1.13,2.79),72 h为2.40(1.60,4.90)比1.40(0.92,2.54),均P<0.05〕,24 h和72 h ALB、72 h Hb和72 h PLT水平均明显降低〔ALB(g/L):24 h为26.45±5.08比29.18±2.86,72 h为29.06±4.81比31.40±3.67;72 h Hb(g/L):90.53±10.84比98.24±13.42,72 h PLT(×109/L):38(28,106)比100(54,134),均P<0.05〕,撤机成功比例亦明显降低〔52.6%(10/19)比89.2%(33/37),P<0.05〕,ECMO支持时间明显延长〔d:8.0(7.0,11.0)比5.0(4.0,8.5),P<0.05〕;COX回归分析显示:患者VA-ECMO上机后24 h低ALB、24 hObjective To explore the factors influencing the prognosis of patients with veno-arterial extracorporeal membrane oxygenation(VA-ECMO).Methods A retrospective analysis was conducted on the clinical data of VA-ECMO patients admitted to Affiliated Jinhua Hospital to Zhejiang University School of Medicine from January 2019 to October 2022.The demographic characteristics,previous diseases,and clinical data at the time of extracorporeal membrane oxygenation(ECMO)establishment,such as whether cardiopulmonary resuscitation(CPR)was performed and whether the transfer was from outside the hospital,whether interventional surgery was performed,whether bleeding occurred during VA-ECMO treatment,whether continuous renal replacement therapy(CRRT)was combined,and whether the machine was successfully withdrawn were recorded.Indicators such as albumin(ALB),procalcitonin(PCT),blood lactate acid(Lac),hemoglobin(Hb),and platelet count(PLT)at 24,48,and 72 hours after ECMO establishment were recorded.The ECMO support time,intensive care unit(ICU)stay time,and total hospital stay time were statistically analyzed.The patients were divided into the survival group and the death group based on the prognosis.The differences in the above clinical indicators between the two groups with different prognoses were compared.The indicators with statistically significant differences in the univariate analysis were included in the multivariate COX regression analysis to screen for the risk factors affecting the prognosis of VA-ECMO patients.The receiver operator characteristic curve(ROC curve)was drawn to analyze the predictive value of each risk factor for the prognosis of patients.Results A total of 56 patients were included,among which 37 cases were in the survival group and 19 cases were in the death group.The ECMO support mode was all VA-ECMO.Compared with the survival group,the proportion of combined CRRT and the levels of PCT at 24,48,and 72 hours,48 hours and 72 hours difference,as well as Lac at 48 hours and 72 hours in the death group were s

关 键 词：体外膜肺氧合 危险因素 回顾性研究 

分 类 号：R459.7[医药卫生—急诊医学]