体外膜肺氧合在老年患者冠状动脉旁路移植术后的应用研究

Extracorporeal membrane oxygenation treatment after coronary artery bypass grafting in elderly patients

目的回顾老年冠状动脉旁路移植(CABG)术后难治性心源性休克患者的体外膜肺氧合(ECMO)辅助情况,分析死亡率及可能影响辅助结果的相关危险因素。方法回顾本中心2011年1月至2014年12月共119例CABG术后出现难治性心源性低心排或术中难以脱离体外循环行ECMO辅助的患者,统计老年(年龄≥65岁)与非老年患者(年龄<65岁)的ECMO辅助结果并分析可能的相关危险因素。结果老年患者42例,平均年龄(69.4±3.5)岁,20例成功脱离ECMO(47.6%),10例存活出院(23.8%);非老年患者77例,平均年龄(55.1±6.6)岁,41例成功脱离ECMO(53.2%),其中33例存活出院(42.9%)。老年患者与非老年患者在下肢缺血(21.4%vs 6.5%)、肾功能不全(42.9%vs 16.9%)及透析应用(31.0%vs 13.0%)存在统计学差异(P<0.05)。Logistic回归分析发现肾功能不全和下肢缺血是影响CABG术后患者ECMO辅助结果的独立危险因素。结论对于CABG术后难治性心源性休克的老年冠心病患者,ECMO是一种有效的辅助治疗措施;下肢缺血、肾功能不全是影响ECMO辅助结果的独立危险因素。

Objective o retrospectively study the outcome of extracorporeal membrane oxygenation（ECMO） in elderly patients with refractory postoperative cardiogenic shock（PCS） after coronary artery bypass grafting（CABG） from our center,and to analyze the possible risk factors.Methods A total of 119 consecutive patients treated with ECMO because of PCS after CABG or unsuccess fully weaning from cardiopulmonary bypass（CPB） during surgery from January 2011 to December 2014 were reviewed.Logistic analysis was performed to identify the risk factors of the clinical outcome.Results There were 42 elderly patients（ 〉= 65years） with a mean age of 69.4±3.5 years.Twenty cases（47.6%） success fully weaned from ECMO and ten cases（23.8%） were discharged from hospital.There were 77 non-elderly patients（〈65 years） with a mean age of 55.1±6.6 years.Forty-one（53.2%） cases success fully weaned from ECMO and 33（42.9%） cases were discharged from hospital.Between the elderly and non-elderly patients,significant difference was noted in lower limb ischemia（21.4%vs 6.5%）,renal failure（42.9%vs 16.9%） and the frequency of dialysis（31.0%vs 13.0%）.Logistic analysis found that renal failure and lower limb ischemia wereindependent risk factors associated with theclinical outcome of patients.Conclusions ECMO is an effective treatment for eldely patients with PCS after CABG;Renal failure and lower limb ischemia are indepedent risk factors of the outcome of ECMO support.