体外膜肺氧合治疗急性失代偿性心力衰竭患者临床特征及预后危险因素的分析

Clinical characteristics and prognostic risk factors of patients with acute decompensated heart failure treated by extracorporeal membrane oxygenation

目的评价静-动脉体外膜肺氧合(VA-ECMO)治疗急性失代偿性心力衰竭(aDHF)患者的临床特征及预后不良危险因素。方法回顾分析2015-01-2017-12石河子市人民医院ICU治疗的96例aDHF患者的临床资料,总结其临床特征。根据患者1年存活情况,将患者分为死亡组和存活组,比较两组患者的人口统计学资料、心肌病类型、疾病严重程度、体外膜肺氧合(ECMO)治疗特征、疾病发作时间、实验室指标和预后。采用Logistics回归分析,评价患者1年死亡的独立危险因素。结果患者的1年存活率为42.7%(41/96),死亡率为57.3%(55/96)。单因素分析表明,患者死亡的相关因素包括:年龄(t=2.005,P=0.047)、特发性心脏病(X^2=5.985,P>=0.014)、心肌病病程(t=15.735,P<0.001)、入院SAPSⅡ评分(z=15.382,P<0.001)、输助治疗前SOFA评分(z=4.366,P<0.001)、肺(x^2=6.192,P=0.013)肾(x^2=5.692,P=0.017)肝(x^2=7.754,P=0.005)衰竭、心脏骤停(x2=4.174,P=0.041)、ECMO辅助体外心肺复苏(ECRP,x^2=5.245,P=0.022)与血乳酸水平(x^2=5.518,P<0.001)。患者1年死亡的独立危险因素包括:SOFA评分>11分(p=0.022)、心脏病持续时间>2年(P=0.025)、血乳酸>4mmol/L(P=0.047)、特发性心肌病(P=0.023)。ECMO辅助前SOFA评分<7分的患者1年生存率为50.0%,而SOFA评分≥14分者为9.6%,提示ECMO辅助治疗对病情严重的aDHF患者疗效较差。结论经VA-ECM0辅助治疗的aDHF患者1年生存率为42.7%,患者预后主要取决于心脏病的严重程度。经ECMO治疗的多器官功能障碍患者死亡风险更大,临床医师应谨慎对待ECMO辅助前SOFA评分在14分的患者。

Objective To evaluate the clinical characteristics and poor prognostic risk factors of patients with acute decompensated heart failure treated venoarterial extracorporeal membrane oxygenation (VA -ECMO).Methods To retrospective analyze the clinica/data of 96 patients with acute decompensated heart failure treated in ICU.The clinical characteristics of the patients were analyzed. According to the patient's survival for 1year,the patients were divided into the death group and the survival group.The demographic data,eardiomyopathy type,disease severity,ECMO treatment eharaeteristies,disease onset time,laboratory index and prognosis were compared between the two groups.Logistic regression analysis was used to evaluate the independent risk factors for 1-year mortality in patients.Results The 1-year survival rate was 42.7%(41/96)and the mortality rate was 57.3%(55/96).Univariate analysis showed that factors associated with death included age (t =2.005,P =0.047),idiopathic cardiomyopathy (X^2=5.985,P =0.014),years of cardiac disease (t = 15.735,P <0.001),admission to Simplified Acute Physiology Score lI (SAPS IT )(Z =15.382,P < 0.001),adjuvant therapy Pre -sequential organ failure assessment (SOFA)(Z =4.336,P <0.001), lung (X^2=6.192,P =0.013)kidney (X^2=5.692,P =0.017)liver (X^2=70754,P =0.005)failure, cardiac arrest(X^2=4.174,P =0.041),ECMO -assisted extracorporeal eardiopulmonary resuscitation (ECPR)(X^2=5.245,P =0.022)and blood lactate (t =5.518,P <0.001).Independent risk factors for 1-year mortality included :SOFA score >11(P =0.022),duration of heart disease >2years (P = 0.025),blood lactate >4mmol/L (P =0.047)and idiopathic cardiomyopathy (P =0.023).The 1- year survival rate of patients with ECMO -assisted SOFA score <7was 50.0%,and that of patients with SOFA score of ≥14was 9.6%,suggesting that ECMO -assisted therapy is less effective in patients with severe decompensated heart failure.Conelusion The 1-year survival rate of patients with acute decompensated heart failure treated with VA -EMCO is 42.7%.The prognosis of a patient depends mainly on the severity of the heart disease.Patients with multiple organ failure treated with ECMO are at greater risk of death.Clinicians should be cautious about the patients with an ECMO -assisted SOFA score of no less than 14.