体外膜肺氧合治疗重度急性呼吸窘迫综合征效果的影响因素分析

Analysis of the influence factors of the clinical effects of extracorporeal membrane oxygenation on severe acute respiratory distress syndrome

目的探讨体外膜肺氧合(ECMO)治疗重度急性呼吸窘迫综合征(ARDS)效果的影响因素。方法回顾性收集和分析郑州大学第二附属医院重症医学科2012年8月至2015年6月收治的28例应用静脉-静脉ECMO(VV-ECMO)治疗重度ARDS患者临床资料,根据应用ECMO后3个月是否存活,分为生存组和死亡组。采用SPSS17.0对收集资料进行统计分析。结果 28例患者行ECMO前均已行有创机械通气,平均(70.86±24.93)h。两组患者年龄、ECMO前有创通气时间、发病至应用ECMO时间、入院至用ECMO时间和ECMO治疗时间比较,差异有统计学意义(P<0.05)。两组原发病构成比较,差异无统计学意义(P>0.05)。两组在治疗前6 h内心率、平均动脉压、动脉血p H和血乳酸水平、血降钙素原水平比较,差异有统计学意义(P<0.05)。结论 VV-ECMO是治疗重度ARDS的有效支持手段。年龄、应用ECMO前的机械通气时间、发病至应用ECMO时间和心率、平均动脉压、血乳酸水平和血降钙素原水平等可能是影响患者预后的重要因素。

Objective To summarize the factors of severe acute respiratory distress syndrome （ARDS）patients treated with extracorporeal membrane oxygenation（ECMO）.Methods The clinical data of twenty-eight patients with severe ARDS,who met the ECMO criteria,supposed with ECMO in intensive care unit of the Second Affiliated Hospital of Zhengzhou University from August of 2012 to June of 2015 were retrospectively collected and analyzed.Patients were divided into survival group and non-survival group according to the three months situation after ECMO treatment.The statistics software of SPSS 17.0 was used for data analysis.Results 28 patients were treated with VV-ECMO.Mean time of mechanical ventilation before ECMO thera-py was （70.86 ±24.93）h.These factors,such as the age,the time of pre-ECMO mechanical ventilation,the time between paroxysm and ECMO support,were significantly different between the both groups （P〈0.05 ）,while there was no statistically significant difference in the pathogenesis of ARDS （P〉0.05）.Those factors,such as the heart rate,the mean arterial pressure, the serum lactate level and the serum procalcitonin level were significantly different between the both groups in the six hours pre-ECMO （P〈0.05）.Conclusion VV-ECMO may be an effective extracorporeal life support treatment for severe ARDS. These indexes,such as the age,the time of mechanical ventilation before ECMO therapy,the time between paroxysm and ECMO ther-apy,HR,MAP,the serum lactate level and the serum procalcitonin level,may be the risk factors for the patient’s prognosis.