心源性休克患者接受体外膜肺氧合治疗后早期血清炎症因子水平及其对患者短期死亡风险的预测价值  

Early serum inflammatory cytokine levels and their predictive value for short-term mortality risk in patients with cardiogenic shock undergoing extracorporeal membrane oxygenation therapy

作　　者：吴跃明[1] 徐俊龙[1] 章贤 邓勋涛 WU Yueming;XU Junlong;ZHANG Xian;DENG Xuntao(Department of Intensive Care Unit,Lishui People's Hospital,Lishui,Zhejiang,323000,China)

机构地区：[1]丽水市人民医院重症医学科,浙江丽水323000

出　　处：《临床急诊杂志》2025年第3期203-207,共5页Journal of Clinical Emergency

摘　　要：目的:探讨心源性休克患者接受体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)治疗后早期血清炎症因子水平及其对患者短期死亡风险的预测价值。方法:回顾性分析2020年3月—2024年2月收治的经ECMO治疗的心源性休克患者20例为研究对象,依据患者28 d内是否死亡分为存活组(7例)和死亡组(13例)。分析比较存活组和死亡组患者第1天及第3天急性生理与慢性健康评分(acute physiology and chronic health evaluation,APACHEⅡ)、序贯器官衰竭评分(sequential organ failure assessment,SOFA)和血清炎症因子变化及其对患者短期死亡风险的预测价值。结果:单因素分析显示,ECMO治疗的心源性休克患者28 d内存活组与死亡组在第1天APACHEⅡ评分和SOFA评分、第3天APACHEⅡ评分、SOFA评分、神经元特异性烯醇化酶(neuron-specific enolase,NSE)、乳酸(lactate,LAC)、D-二聚体、肌钙蛋白、心脏射血分数(EF值)、肌酐等方面比较,差异有统计学意义(P<0.05)。分别以第1天APACHEⅡ评分和SOFA评分、第3天APACHEⅡ评分、SOFA评分、NSE、LAC、D-二聚体、肌钙蛋白、EF值、肌酐指标为参考,预测ECMO治疗心源性休克患者28 d内死亡的受试者工作特征曲线下面积为0.813~0.923,且差异有统计学意义(P<0.05)。结论:心源性休克患者接受ECMO治疗后28 d死亡与存活患者血清炎症因子水平及APACHEⅡ评分、SOFA评分存在显著差异,且可作为预测患者短期死亡风险的指标。Objective To explore the early serum inflammatory cytokine levels and their predictive value for short-term mortality risk in patients with cardiogenic shock undergoing extracorporeal membrane oxygenation(ECMO)therapy.Methods A retrospective analysis was conducted on 20 patients with cardiogenic shock treated with ECMO from March 2020 to February 2024.Patients were divided into a survival group(7 cases)and a death group(13 cases)based on whether they died within 28 days.The acute physiology and chronic health evaluation(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,and changes in serum inflammatory factors on the first and the third days between the survival and death groups were compared,and their predictive value for short-term mortality risk in patients were analyzed.Results Univariate analysis showed that there were significant differences in APACHEⅡ score and SOFA score on the first day,APACHEⅡscore,SOFA score,neuron-specific enolase(NSE),lactate(LAC),D-dimer,troponin,ejection fraction(EF)value,creatinine,and other parameters on the third days between the survival group and the death group of patients with cardiogenic shock treated with ECMO at 28 days(P<0.05).Using the APACHEⅡ score and SOFA score on the first day,as well as the APACHEⅡ score,SOFA score,NSE,LAC,D-dimer,troponin,EF value,and creatinine index on the third day as references,the area under the receiver operating characteristic curve for predicting death within 28 days of ECMO treatment in patients with cardiogenic shock ranged from 0.813 to 0.923,and the difference was statistically significant(P<0.05).Conclusion There are significant differences in serum inflammatory cytokine levels,APACHEⅡscore,and SOFA score between patients who died and survived within 28 days after receiving ECMO therapy for cardiogenic shock,and they can be used as indicators to predict the short-term mortality risk of patients.

关 键 词：心源性休克 体外膜肺氧合 炎症因子 预后 预测价值 

分 类 号：R541.6[医药卫生—心血管疾病]