探讨早期容量平衡对重症心源性休克静脉-动脉体外膜肺氧合治疗患者预后的影响  

Exploring the impact of early volume balance on the prognosis of patients with severe cardiogenic shock treated with veno-arterial extracorporeal membrane oxygenation

作　　者：邓海芳 刘建凌 杨惠钊 李华楚 DENG Hai-fang;LIU Jian-ling;YANG Hui-zhao(Qingyuan Hospital Affiliated to Guangzhou Medical University(Qingyuan People's Hospital),Qingyuan 511518,China)

机构地区：[1]广州医科大学附属清远医院(清远市人民医院),511518

出　　处：《中国实用医药》2025年第5期40-43,共4页China Practical Medicine

摘　　要：目的探讨早期容量平衡对重症心源性休克静脉-动脉体外膜肺氧合(VA-ECMO)治疗患者预后的影响。方法收集100例重症心源性休克VA-ECMO治疗患者的资料进行回顾性分析,根据前3 d容量平衡结果将患者分成正平衡组(50例)和负平衡组(50例),按照预后情况将患者分为存活组(54例)和死亡组(46例)。比较正平衡组和负平衡组的基本资料[年龄、性别、急性生理与慢性健康评分Ⅱ(APACHEⅡ)评分、体外膜肺氧合(ECMO)辅助时间]、治疗及预后情况[联合连续性肾脏替代治疗(CRRT)率、联合主动脉内球囊反搏(IABP)率、有创机械通气率、存活率],存活组和死亡组前72 h的每个24 h容量平衡情况。结果正平衡组和负平衡组的年龄、性别、APACHEⅡ评分比较,无统计学意义(P>0.05);负平衡组ECMO辅助时间(98.5±14.4)h短于正平衡组的(110.7±36.4)h,存在统计学意义(P<0.05)。负平衡组联合CRRT率40.00%、有创机械通气率68.00%低于正平衡组的76.00%、90.00%,存活率72.00%高于正平衡组的36.00%,存在统计学意义(P<0.05);正平衡组和负平衡组联合IABP率比较,无统计学意义(P>0.05)。存活组和死亡组48~72 h容量平衡比较,无统计学意义(P>0.05);存活组0~24 h、24~48 h、前72 h总和容量平衡优于死亡组,存在统计学意义(P<0.05)。结论对于重症心源性休克VA-ECMO治疗患者,容量管理,特别是早期容量负平衡可以影响患者预后,在前48 h液体负平衡有更好的存活率,并减少ECMO辅助时间和CRRT率。Objective To explore the impact of early volume balance on the prognosis of patients with severe cardiogenic shock undergoing veno-arterial extracorporeal membrane oxygenation(VA-ECMO).Methods A retrospective analysis was conducted on 100 patients with severe cardiogenic shock treated with VA-ECMO.Patients were divided into positive balance group(50 cases)and negative balance group(50 cases)according to the results of volume balance in the first 3 d,and the patients were divided into survival group(54 cases)and death group(46 cases)according to the prognosis.Comparison of basic data[age,gender,acute physiological and chronic health evaluationⅡ(APACHEⅡ)score,duration of extracorporeal membrane oxygenation(ECMO)support],treatment and prognosis[combined continuous renal replacement therapy(CRRT)rate,combined intra-aortic balloon counterpulsation(IABP)rate,invasive mechanical ventilation rate,survival rate]between positive balance group and negative balance group,as well as each 24-h volume balance during the first 72 h in the survival and death groups.Results There was no significant difference in age,gender and APACHEⅡscore between positive balance group and negative balance group(P>0.05).The duration of ECMO support of(98.5±14.4)h in negative balance group was shorter than(110.7±36.4)h in positive balance group,and there was statistical significance(P<0.05).The combined CRRT rate and invasive mechanical ventilation rate were 40.00%and 68.00%in negative balance group,which were lower than 76.00%and 90.00%in positive balance group;the negative balance group had higher survival rate of 72.00%than 36.00%in positive balance group;there was statistical significance(P<0.05).There was no statistical significance in the combined IABP rate between positive balance group and negative balance group(P>0.05).There was no statistical significance in volume balance between survival group and death group during the first 48-72 h(P>0.05).The total volume balance during the first 0-24 h,24-48 h and 72 h in survival group was

关 键 词：早期容量平衡 重症心源性休克 静脉-动脉体外膜肺氧合 预后 

分 类 号：R47[医药卫生—护理学]