静脉-动脉体外膜肺氧合早期容量超负荷的管理效果研究

Effect of volume management on early capacity overload in patients with VA-ECMO patients

目的:评价基于ABC管理法的容量管理对心力衰竭的静脉-动脉体外膜肺氧合(Veno-Arterial Extracorporeal Membrane Oxygenation,VAECMO)患者早期容量超负荷的作用,为VA-ECMO患者的容量管理提供参考。方法:采用回顾性研究方法,以2019年3月至2024年3月在天津市某三级甲等医院心内科重症监护室接受VA-ECMO治疗的心力衰竭患者为研究对象,以2019年3月至2021年11月接受常规容量管理的19例患者为对照组,以2021年12月至2024年3月接受ABC容量管理法的19例患者为观察组,比较两组患者VA-ECMO治疗3天的容量管理效果。结果:观察组平均动脉压、中心静脉压低于对照组,差异有统计学意义(P<0.05);两组累计液体平衡量差异无统计学意义(P>0.05);观察组左室射血分数升高幅度更大(P=0.020),脑钠肽水平降低幅度更大(P=0.002);两组血肌酐水平差异无统计学意义(P>0.05),但观察组第3天比第2天明显降低(P=0.033)。结论:应用ABC容量管理法可降低VA-ECMO患者早期容量负荷,有效改善心功能,加快肾功能的恢复,从而降低肺水肿、急性肾损伤等并发症的发生风险。

Objective:To explore the effect of ABC-based volume management on early volume overload in heart failure patients with Venous-Arterial Extracorporeal Membrane Oxygenation(VA-ECMO),and provide a reference for volume management in VA-ECMO patients.Methods:A retrospective study was conducted on heart failure patients who received VA-ECMO treatment in the Coronary Care Unit of a tertiary grade A hospital in Tianjin from March 2019 to March 2024.Nineteen patients with conventional volume management from March 2019 to November 2021 were selected as the control group,and nineteen patients with ABC volume management from December 2021 to March 2024 were selected as the observation group.The effects of volume management within 3 days on patients with VA-ECMO treatment were compared between the two groups.Results:The mean arterial pressure and central venous pressure in the observation group were lower than those in the control group(P<0.05).There was no significant difference in the cumulative liquid balance between the two groups(P>0.05).There was a greater increase in left ventricular ejection fraction(P=0.020)and a greater decrease in brain natriuretic peptide(P=0.002)in the observation group.There was no statistically significant difference in creatinine levels between the two groups(P>0.05),while there was a significant decrease in creatinine level on the third day compared to those on the second day in the observation group(P=0.033).Conclusion:The application of ABC-based volume management is benefit to reduce the early volume load in patients with VA-ECMO,effectively improve the cardiac function,accelerate the recovery of renal function,and reduce the risk of pulmonary edema and acute kidney injury.