中国体外循环杂志
中國體外循環雜誌
중국체외순배잡지
CHINESE JOURNAL OF EXTRACORPOREAL CIRCULATION
2014年
4期
210-214
,共5页
杜中涛%杨峰%江春景%邢家林%缪娜%刘锋%杨晓芳%江瑜%李蛟%侯晓彤
杜中濤%楊峰%江春景%邢傢林%繆娜%劉鋒%楊曉芳%江瑜%李蛟%侯曉彤
두중도%양봉%강춘경%형가림%무나%류봉%양효방%강유%리교%후효동
机械循环辅助%体外生命支持%心脏外科%心源性休克%危险因素
機械循環輔助%體外生命支持%心髒外科%心源性休剋%危險因素
궤계순배보조%체외생명지지%심장외과%심원성휴극%위험인소
Mechanical circulatory assistance%Extracorporeal membrane oxygenation%Cardiacsurgery%Cardiogenic shock%Risk factors
目的:探讨体外膜肺氧合( ECMO)对心脏手术后难治性心源性休克提供临时机械循环支持的应用效果及早期死亡率危险因素分析。方法回顾分析本院2012年1月至2012年12月期间,6986名成人心脏术后患者中有54例(0.77%)患者因为术后心源性休克而应用静脉动脉( VA) ECMO支持。使用指证包括:心脏术后难以脱离体外循环,容量合适的情况下大剂量的血管活性药物应用和/或者应用主动脉内气囊反搏( IABP )仍难以维持血流动力学稳定。其中有11例(20%)患者因为各种原因支持时间少于24 h未纳入统计分析。结果43例患者平均年龄为59.0岁,男性30例,女性13例。 ECMO平均支持时间是5.1 d。31例(72.1%)患者成功脱离ECMO辅助。30 d及1年死亡率分别为60.5%(27/43)和69.8%(30/43)。ECMO患者院内死亡率为65.1%(28/43)。对出院患者进行门诊随访,ECMO患者1年生存率为30.2%(13/43)。 Logistic回归分析发现患者应用ECMO后72 h左室射血分数( LVEF)≤30%和ECMO应用3 d内悬浮红细胞输入量是院内死亡率的重要预测因子( OR=14.76,95% CI=2.34-93.25, P =0.004;OR=0.60,95% CI=0.38-0.94, P =0.03)。结论 ECMO为心脏术后严重心源性休克患者提供了一个有效的临时心肺支持。辅助期间较低的LVEF和较多的悬浮红细胞输入量是影响死亡率的危险因素。在 ECMO辅助支持期间,应该每日监测LVEF变化及悬浮红细胞的输入量。
目的:探討體外膜肺氧閤( ECMO)對心髒手術後難治性心源性休剋提供臨時機械循環支持的應用效果及早期死亡率危險因素分析。方法迴顧分析本院2012年1月至2012年12月期間,6986名成人心髒術後患者中有54例(0.77%)患者因為術後心源性休剋而應用靜脈動脈( VA) ECMO支持。使用指證包括:心髒術後難以脫離體外循環,容量閤適的情況下大劑量的血管活性藥物應用和/或者應用主動脈內氣囊反搏( IABP )仍難以維持血流動力學穩定。其中有11例(20%)患者因為各種原因支持時間少于24 h未納入統計分析。結果43例患者平均年齡為59.0歲,男性30例,女性13例。 ECMO平均支持時間是5.1 d。31例(72.1%)患者成功脫離ECMO輔助。30 d及1年死亡率分彆為60.5%(27/43)和69.8%(30/43)。ECMO患者院內死亡率為65.1%(28/43)。對齣院患者進行門診隨訪,ECMO患者1年生存率為30.2%(13/43)。 Logistic迴歸分析髮現患者應用ECMO後72 h左室射血分數( LVEF)≤30%和ECMO應用3 d內懸浮紅細胞輸入量是院內死亡率的重要預測因子( OR=14.76,95% CI=2.34-93.25, P =0.004;OR=0.60,95% CI=0.38-0.94, P =0.03)。結論 ECMO為心髒術後嚴重心源性休剋患者提供瞭一箇有效的臨時心肺支持。輔助期間較低的LVEF和較多的懸浮紅細胞輸入量是影響死亡率的危險因素。在 ECMO輔助支持期間,應該每日鑑測LVEF變化及懸浮紅細胞的輸入量。
목적:탐토체외막폐양합( ECMO)대심장수술후난치성심원성휴극제공림시궤계순배지지적응용효과급조기사망솔위험인소분석。방법회고분석본원2012년1월지2012년12월기간,6986명성인심장술후환자중유54례(0.77%)환자인위술후심원성휴극이응용정맥동맥( VA) ECMO지지。사용지증포괄:심장술후난이탈리체외순배,용량합괄적정황하대제량적혈관활성약물응용화/혹자응용주동맥내기낭반박( IABP )잉난이유지혈류동역학은정。기중유11례(20%)환자인위각충원인지지시간소우24 h미납입통계분석。결과43례환자평균년령위59.0세,남성30례,녀성13례。 ECMO평균지지시간시5.1 d。31례(72.1%)환자성공탈리ECMO보조。30 d급1년사망솔분별위60.5%(27/43)화69.8%(30/43)。ECMO환자원내사망솔위65.1%(28/43)。대출원환자진행문진수방,ECMO환자1년생존솔위30.2%(13/43)。 Logistic회귀분석발현환자응용ECMO후72 h좌실사혈분수( LVEF)≤30%화ECMO응용3 d내현부홍세포수입량시원내사망솔적중요예측인자( OR=14.76,95% CI=2.34-93.25, P =0.004;OR=0.60,95% CI=0.38-0.94, P =0.03)。결론 ECMO위심장술후엄중심원성휴극환자제공료일개유효적림시심폐지지。보조기간교저적LVEF화교다적현부홍세포수입량시영향사망솔적위험인소。재 ECMO보조지지기간,응해매일감측LVEF변화급현부홍세포적수입량。
[ Abstract]:Objective Analysis of risk factors of early mortality and outcome during extracorporeal membrane oxygenation ( ECMO) support for those with refractory cardiogenic shock after cardiac surgery. Methods Between January 2012 and December 2012, 6986 patients underwent cardiac surgery in our adult cardiac critical care unit. Among those, 54 patients (0.77%) were suppor?ted with veno-arterial ECMO for cardiac support because of refractory postcardiotomy cardiogenic shock. Indications for ECMO support included:failure to wean from cardiopulmonary bypass, or refractory cardiogenic shock development despite adequate filling volumes, large-dose inotropes and/or intra-aortic balloon pump support. 11 patients ( 20%) were excluded because the support time was less than 24 hours. The short-term and medium-term results of these patients were analyzed, and in addition, the prognostic factors of sur?vival were predicted. Results Patients'average age was 59.0 ±12.2 years. There were 30 male and 13 female patients. Overall mean support time was 5.1±4.1 days. Thirty-one (72.1%) patients could be successfully weaned from ECMO. The 30-day and 1-year mor?talities were 60.5% (27/43) and 69.8% (30/43), respectively. The in-hospital mortality was 65.1% (28/43). Thirteen (30.2%) patients were still alive at 1-year out-patient follow up. Stepwise logistic regression identified left-ventricular ejection fraction ( LVEF)≤30% at 72 h after ECMO initiation and number of packed red blood cells ( PRBCs) transfused during ECMO as significant predictors of mortality [ odds ratio ( OR)=14.76;95% confidence interval ( CI)=2.34-93.25;P =0.004 and OR=0.60;95% CI=0.38-0.94, P =0.03, respectively] . Conclusion ECMO provides a good temporary cardiopulmonary support in patients with postcardiotomy cardiogenic shock. The risk factor of mortality is poor LVEF after ECMO support, so the LVEF should be strictly monitored everyday during ECMO support.