体外膜肺氧合辅助成人心肺复苏患者预后的回顾性分析

杨巍.体外膜肺氧合辅助成人心肺复苏患者预后的回顾性分析[J].内科急危重症杂志,2024,30(5):429-434

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DOI：10.11768/nkjwzzzz.20240511

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基金项目:湖北省教育厅科研项目（B2020103）；湖北省卫生健康委员会指导项目（WJ2021F039）

作者	单位	E-mail
杨巍	湖北医药学院附属人民医院	28799898@qq.com

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中文摘要:

摘要目的：分析体外膜肺氧合(ECMO)辅助成人体外心肺复苏(ECPR）患者预后的影响因素。方法：收集实施ECPR治疗的92例患者的临床资料并进行回顾性队列研究。根据患者出院时是否存活将其分为存活组（27例）和死亡组(65例)，分析2组间的基本资料、体外心肺复苏启动前、后的相关资料。结果：92例患者的存活率为29.34%。ECMO启动前，存活组院外心搏骤停患者比例、患者血乳酸水平低于死亡组，血pH、HCO3-水平高于死亡组（P均＜0.05）；ECMO启动后，存活组中持续高乳酸血症患者比例、血清天门冬氨酸氨基转移酶水平低于死亡组、ECPR时间短于死亡组，初期平均动脉压(MAP)水平高于死亡组（P均＜0.05）。二元Logistic回归分析显示：ECPR时间（OR=0.764，95%CI 0.63～0.927，P=0.006）、初期MAP水平（OR=1.228，95%CI 1.026～1.470，P=0.025）是预测ECPR患者死亡的独立危险因素。结论：ECPR是救治心搏骤停患者的有效手段，快速实施ECPR及初期MAP＞66mmHg预示患者预后良好。

英文摘要:

Abstract Objective: To analyze the influencing factors of adults receiving extracorporeal cardiopulmonary resuscitation(ECPR). Methods: A retrospective cohort study was conducted on 92 patients who were treated with ECPR in the Emergency and Critical Care Center. Patients were divided into survival group (n=27) and death group (n=65) according to the clinical outcome. The basic data of the two groups and the relevant data before and after initiation of ECPR were analyzed. Results: The survival rate of 92 patients was 29.34%. At the beginning of extracorporeal membrane oxygenation (ECMO), the lactate level and the proportion of out-of-hospital cardiac arrest (OHCA) in the survival group were lower than those in the death group, and the pH and HCO3- levels in the survival group were higher than those in the death group (all P<0.05). After initiation of ECMO, the proportion of patients with persistent hyperlactic acidemia, AST levels and ECPR time in the survival group were obviously reduced as compared with those in the death group, and the initial mean arterial pressure (MAP) in the survival group was obviously higher than that in the death group (all P<0.05). Logistic regression analysis showed that ECPR time (OR=0.764, 95%CI 0.63-0.927,P=0.006), initial MAP (OR=1.228, 95%CI 1.026-1.470, P=0.025) were independent risk factors for ICU death in ECPR patients. Conclusions: The data show that ECPR is an effective treatment for patients with cardiac arrest. The prognosis of ECPR is significantly related to the duration of ECPR and initial MAP>66mmHg.