成人心脏术后心源性休克患者接受体外膜肺氧合辅助的临床结果荟萃分析

Clinical outcomes of adults with postcardiotomy cardiogenic shock undergoing venoarterial extracorporeal membrane oxygenation: A systematic review and meta-analysis

目的本研究旨在通过检索相关文献,系统评价体外膜肺氧合(ECMO)对心脏术后心源性休克(PCS)患者的临床疗效。方法通过搜索PubMed,Embase及Cochrane Library for English等数据库查找PCS行ECMO患者的相关研究进行荟萃分析。结果最终选取14项观察性研究进行荟萃分析。接受ECMO的PCS患者的院内死亡率为66.0%(95%CI 61%～71%)。合并1年生存率为24%(95%CI 19%～30%)。合并中期生存率为19%(95%CI 10%～34%)。下肢缺血发生合并率为14%(95%CI 10%～20%)。二次手术发生合并率为44%(95%CI 21%～70%)。肾功能衰竭发生的合并率为49%(95%CI38%～61%)。神经系统并发症发生的合并率为18%(95%CI 11%～29%)。感染发生的合并率为23%(95%CI 16%～31%)。大部分纳入的研究表明,年龄>65岁、ECMO前或ECMO后血乳酸值升高、肾功能不全、ECMO持续时间长以及神经系统并发症是接受ECMO治疗的PCS患者院内死亡的危险因素。结论接受ECMO治疗的PCS患者的短期和中期生存率较低,EC-MO并发症的发生率相对较高,许多危险因素与院内死亡率有关。

Objective This study was designed to investigate the clinical outcomes of adults with postcardiotomy cardiogenic shock undergoing venoarterial extracorporeal membrane oxygenation.Methods We searched PubMed,Embase,Cochrane Library and other databases to find out relevant studies of postoperative ECMO patients for meta-analysis.Results Fourteen observational studies were selected for final analysis.The pooled mortality rate to hospital discharge was 66.0%(95%CI 0.61,0.71)in PCS patients re.ceiving ECMO.The pooled 1-year survival rate was 24%(95%CI 0.19,0.30).The pooled midterm survival rate was 19%(95%CI 0.10,0.34).The pooled rate of lower limb ischemia was 14%(95%CI 0.10,0.20).The pooled rate of reoperation was 44%(95%CI 0.21,0.70).The pooled rate of renal failure was 49%(95%CI 0.38,0.61).The pooled rate of neurologic complications was 18%(95%CI 0.11,0.29).The pooled rate of infection was 23%(95%CI 0.16,0.31).Most of the included studies commonly revealed that age>65 years,pre-ECMO or post-ECMO blood lactate,renal insufficiency,long duration of ECMO,and neurologic complications were risk factors of in-hospital mortality in PCS patients undergoing ECMO.Conclusion The short-term and midterm survival rates of PCS patients treated with ECMO were relatively low,and post-ECMO complication rates were relatively high.Many risk factors were related to in-hospital mortality.