中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2014年
12期
749-752
,共4页
臧芝栋%许红阳%董亮%严洁
臧芝棟%許紅暘%董亮%嚴潔
장지동%허홍양%동량%엄길
乳酸%体外膜氧合作用%休克,心源性%预后
乳痠%體外膜氧閤作用%休剋,心源性%預後
유산%체외막양합작용%휴극,심원성%예후
Lactic acid%Extracorporeal membrane oxygenation%Shock,cardiogenic%Prognosis
目的 探讨心源性休克患者行体外膜肺氧合(ECMO)治疗后早期乳酸清除率对患者预后的意义.方法 前瞻性选取2010年5月至2013年5月我院重症医学科(ICU)收治的因心源性休克而接受静脉-动脉(V-A) ECMO治疗的患者共47例.分别在接受ECMO治疗前Oh和ECMO治疗后6h测定动脉血乳酸值,计算早期(6 h)乳酸清除率.以接受ECMO治疗后90天为研究终点,将患者分为生存组(25例)和死亡组(22例),比较两组患者早期乳酸清除率.采用受试者工作特征(ROC)曲线分析早期乳酸清除率对患者预后的评估价值.运用Kaplan-Meier法绘制患者的生存曲线,Log-rank法分析患者生存情况.多因素logistic回归分析影响患者预后的危险因素.结果 生存组早期乳酸清除率高于死亡组[(38.6±15.1)％对(14.4±13.8)％,P＜0.05].早期乳酸清除率预测患者90天死亡的ROC曲线下面积为0.869±0.075(95％ CI:0.753～0.991),以≥20.0％作为评估预后的最佳界值点,敏感性和特异性分别为92.0％和85.0％.Kaplan-Meier生存曲线分析显示,高乳酸清除率患者(≥20.0％)和低乳酸清除率患者(＜20.0％)90天生存率分别为66.7％和35.0％,组间比较差异有统计学意义(P＜0.05).多因素Logistic回归分析显示6h乳酸清除率(OR =3.156,95％ CI:2.326～7.253,P＜0.05)是患者死亡的独立危险因素之一.结论 早期乳酸清除率是评估接受ECMO治疗的心源性休克患者预后的重要指标.
目的 探討心源性休剋患者行體外膜肺氧閤(ECMO)治療後早期乳痠清除率對患者預後的意義.方法 前瞻性選取2010年5月至2013年5月我院重癥醫學科(ICU)收治的因心源性休剋而接受靜脈-動脈(V-A) ECMO治療的患者共47例.分彆在接受ECMO治療前Oh和ECMO治療後6h測定動脈血乳痠值,計算早期(6 h)乳痠清除率.以接受ECMO治療後90天為研究終點,將患者分為生存組(25例)和死亡組(22例),比較兩組患者早期乳痠清除率.採用受試者工作特徵(ROC)麯線分析早期乳痠清除率對患者預後的評估價值.運用Kaplan-Meier法繪製患者的生存麯線,Log-rank法分析患者生存情況.多因素logistic迴歸分析影響患者預後的危險因素.結果 生存組早期乳痠清除率高于死亡組[(38.6±15.1)％對(14.4±13.8)％,P＜0.05].早期乳痠清除率預測患者90天死亡的ROC麯線下麵積為0.869±0.075(95％ CI:0.753～0.991),以≥20.0％作為評估預後的最佳界值點,敏感性和特異性分彆為92.0％和85.0％.Kaplan-Meier生存麯線分析顯示,高乳痠清除率患者(≥20.0％)和低乳痠清除率患者(＜20.0％)90天生存率分彆為66.7％和35.0％,組間比較差異有統計學意義(P＜0.05).多因素Logistic迴歸分析顯示6h乳痠清除率(OR =3.156,95％ CI:2.326～7.253,P＜0.05)是患者死亡的獨立危險因素之一.結論 早期乳痠清除率是評估接受ECMO治療的心源性休剋患者預後的重要指標.
목적 탐토심원성휴극환자행체외막폐양합(ECMO)치료후조기유산청제솔대환자예후적의의.방법 전첨성선취2010년5월지2013년5월아원중증의학과(ICU)수치적인심원성휴극이접수정맥-동맥(V-A) ECMO치료적환자공47례.분별재접수ECMO치료전Oh화ECMO치료후6h측정동맥혈유산치,계산조기(6 h)유산청제솔.이접수ECMO치료후90천위연구종점,장환자분위생존조(25례)화사망조(22례),비교량조환자조기유산청제솔.채용수시자공작특정(ROC)곡선분석조기유산청제솔대환자예후적평고개치.운용Kaplan-Meier법회제환자적생존곡선,Log-rank법분석환자생존정황.다인소logistic회귀분석영향환자예후적위험인소.결과 생존조조기유산청제솔고우사망조[(38.6±15.1)％대(14.4±13.8)％,P＜0.05].조기유산청제솔예측환자90천사망적ROC곡선하면적위0.869±0.075(95％ CI:0.753～0.991),이≥20.0％작위평고예후적최가계치점,민감성화특이성분별위92.0％화85.0％.Kaplan-Meier생존곡선분석현시,고유산청제솔환자(≥20.0％)화저유산청제솔환자(＜20.0％)90천생존솔분별위66.7％화35.0％,조간비교차이유통계학의의(P＜0.05).다인소Logistic회귀분석현시6h유산청제솔(OR =3.156,95％ CI:2.326～7.253,P＜0.05)시환자사망적독립위험인소지일.결론 조기유산청제솔시평고접수ECMO치료적심원성휴극환자예후적중요지표.
Objective To evaluate prognostic significance of early lactate clearance rate for cardiogenic shock patients on extracorporeal membrane oxygenation(ECMO).Methods Forty-seven patients with cardiogenic shock supported by venoarterial ECMO were prospectively enrolled from May 2010 to May 2013.Arterial blood lactate at pre-ECMO support(0 h),at post-ECMO 6 hours(6 h) were measured and then 6 h lactate clearance rate was calculated.90 days after admission was the endpoint of research.Patients were divided into the survival group(n =25) and the death group(n =22).6 h lactate clearance rate was compared between groups.The 6 h lactate clearance rate for predicting death was evaluated by receiver operating characteristic(ROC) curves.The surviving curve was drawn using the Kaplan-Meier method,and the survival of the patients was analyzed by the Log-rank test.Factors influencing the prognosis were analyzed by applying the multiplelogistic regression analysis.Results The 6 h lactate clearance rate was higher in survivors than in nonsurvivors [(38.6 ± 15.1) ％ vs.(14.4 ± 13.8) ％,P ＜ 0.05].The area under the ROC curve of 6 h lactate clearance rate for predicting death was 0.869 ± 0.075 (95％ CI:0.753-0.991).The best cutoff point was 20.0％ with a sensitivity of 92.0％ and specificity of 85.0％.KaplanMeier survival analysis showed that 90 days survival rate of high lactate clearance rate group and low lactate clearance rate group were 66.7％ and 35.0％,with significant difference between the two groups(Log-rank test,P ＜ 0.05).Multivariate logistic regression analysis showed that 6 h lactate clearance rate (OR =3.156,95 ％ CI:2.326-7.253,P ＜ 0.05) was one of the independent risk factors associated with mortality of patients on ECMO.Conclusion Early lactate clearance rate could be used as an important maker for evaluating the prognosis of cardiogenic shock patients on ECMO.
