体外膜肺氧合治疗的暴发性心肌炎患者动脉血氧分压拐点对心功能预后的影响

Effect of arterial oxygen partial pressure inflection point on cardiac function in patients with fulminant myocarditis treating by extracorporeal membrane oxygenation

目的:研究VA模式的体外膜肺氧合(ECMO)治疗暴发性心肌炎患者时,动脉血氧分压拐点与心功能及预后的关系,以寻找评估心功能的新指标。方法:回顾性分析2017-07—2019-05期间于我院急诊中心诊断为暴发性心肌炎,且需ECMO治疗的14例患者的临床资料。分析动脉血氧分压拐点与心脏超声射血分数(EF)值、ICU住院天数、住院天数、持续性肾替代治疗(CRRT)时间及28 d病死率的相关性。结果:暴发性心肌炎多发病于青壮年,平均年龄(35.5±18.2)岁,无基础疾病。动脉血氧分压拐点和拐点后EF值呈负相关关系,拐点后床旁超声测得EF值为35%~45%。死亡患者的拐点出现时间明显晚于存活患者,拐点出现时间和CRRT时间呈正相关,与ICU住院时间及住院时间无关。结论:动脉血氧分压拐点出现时间与患者的心功能密切相关,可以用来预测患者病死率。

Objective:To observe the relationship between arterial oxygen partial pressure inflection point and cardiac function and prognosis in patients with fulminant myocarditis requiring veno-arterial extracorporeal membrane oxygenation(VA-ECMO)treatment,so as to search for more sensitive cardiac function evaluation indexes.Method:Data of 14 patients diagnosed with fulminant myocarditis and treating by VA-ECMO in emergency department of the First Affiliated Hospital of Nanjing Medical University from July 2017 to May 2019 were retrospectively analyzed.The correlations between arterial oxygen partial pressure inflection point and EF value,length of ICU stay,length of stay,duration of continuous renal replacement therapy and mortality at 28 days were analyzed.Result:Fulminant myocarditis usually occurs in young adults without underlying diseases,with an average age of(35.5±18.2)years.There was a negative correlation between the inflection point and the EF value,The occurrence time of inflexion in the dead patients was significantly later than that in the surviving patients,and the occurrence time of inflexion was positively correlated with the CRRT time,and had no correlation with the length of stay in ICU or the length of stay in hospital.Conclusion:The occurrence time of arterial oxygen partial pressure inflection point is closely related to cardiac function and can be used to predict mortality.