心脏术后成人体外膜氧合建立时机对预后的影响

Impact of Timing of Extracorporeal Membrane Oxygenation Initiation on Outcomes of Adult Patients After Cardiac Surgery

目的成人心外科术后不同体外膜氧合(extracorporeal membrane oxygenation,ECMO)建立时机是否影响预后的相关研究尚无报道。该研究拟通过单中心回顾研究探讨ECMO建立时机和预后的关系。方法回顾性收集了84例因心源性疾病接受静脉-动脉(venousarterial,VA)ECMO支持的成年患者(≥18周岁)。患者分为术后1天内(early,E组)和术后1天以后(late,L组)两组。结果 65例(77.4%)患者于术后1天内建立ECMO,,建立时间中位数为1 d(0~1d),最长为17 d。E组患者术前NYHA评分3~4级(73.9%vs47.4%,P<0.01)、Euro SCORE评分中~高危组患者(69.2%vs 42.2%,P=0.039)显著高于L组,E组转机时间显著长于L组([314±125]min vs[176±88]min,P<0.01)、建立ECMO的原因不同(P<0.01),E组主要为不能脱机(39/65),L组患者为低心排和或低氧血症(19/19)。ECMO辅助第一天的最高血浆乳酸水平(P=0.02)、平均动脉压最小值(P=0.019)、血小板最小值(P=0.033)E高于L组,最大多巴胺剂量(P=0.019)E组低于L组。ECMO辅助期间,感染(P=0.044),急性肾衰竭(P=0.025)和缺血性肝炎(P=0.032)的发生率在L组中更高。两组患者在血制品的输注量上并无统计学差异。E组在住院期间的全因死亡率低于L组(52.3%[34/65]vs 78.9%[15/19],P=0.038),ECMO辅助时间和ICU停留时间、住院间时两组无显著差异。结论心脏术后早期建立ECMO的患者生存率高,且急性肾衰、缺血性肝炎等并发症发生率较低。

Objective Little is known about the relationship of timing of extracorporeal membrane oxygenation（ECMO） initiation on adult patients＇ outcomes after cardiac surgery. This original article intended to investigate the impact of timing of ECMO initiation on outcomes of adult patients after cardiac operation. Methods A total of 84 consecutive adult（age ≥ 18 years） patients after cardiac surgery requiring venous arterial（VA） ECMO support were studied retrospectively. These patients were divided into Group E（initiation within the 1 st post operation day） and Group L（initiation after the 1 st post operation day）. Results The median timing of ECMO initiation after cardiac surgery was 1 day（IQR 0–1 day, range 0–17 days）. There were 65 patients receiving ECMO support within the 1 st post operation day in total. The NYHA class ification and the Euro SCORE was higher in Group E. The mortality was significantly lower compared with Group L. The CPB duration was the risk factor of initiation ECMO early. And the incidence of acute renal failure and hypoxic hepatitis were higher in Group L. ConclusionsIncreasing timing of initiation is associated with higher mortality rate and high incidence of acute renal failure and hypoxic hepatitis in adult patients after cardiac surgery.