体外膜氧合在老年患者难治性心脏术后心源性休克的应用

Efficacy of extracorporeal membrane oxygenation for postcardiotomy cardiogen⁃ic shock in the elderly patients

目的分析体外膜氧合(ECMO)用于老年患者(年龄≥65岁)难治性心脏术后心源性休克(PCCS)的临床结果。方法总结分析2004年5月至2017年12月间139例老年PCCS患者进行ECMO辅助临床资料,按照是否存活出院分为存活出院组(SG,n=34)和院内死亡组(DG,n=105),分析影响老年患者临床预后的相关风险因素。结果71例(51.1%)患者成功撤机,34例(24.5%)患者存活出院。与SG组患者相比较,DG组患者启动ECMO时乳酸水平、血管活性药物指数和器官衰竭序贯评分较高,差异有统计学意义(P<0.01)。DG组患者ECMO辅助期间严重神经系统并发症和肾脏功能衰竭需要持续性肾替代治疗(CRRT)发生率较高,差异有统计学意义(P<0.01)。多元回归分析结果提示心脏功能衰竭、严重神经系统并发症和需要CRRT的肾脏功能衰竭是影响患者临床预后的独立高危风险因素。结论ECMO能够为老年PCCS患者提供有效循环辅助,挽救部分患者生命。

Objective To analyze the outcomes and to identify the independent predictors of in-hospital mortality in patients o⁃ver 65 years old with postcardiotomy cardiogenic shock(PCCS)requiring extracorporeal membrane oxygenation(ECMO).Methods From May 2004 to December 2017,139 elderly patients with PCCS required ECMO support were collected and analyzed.The patients were divided into two groups by clinical outcomes(in-hospital mortality group,DG,n=105 and survival to discharge group,SG,n=34).Results 71 patients(51.1%)were successfully weaned from ECMO.34 patients(24.5%)survived to discharge.Compared with the SG,DG had a higher plasma lactic acid level,inotrope scores,and sequential organ failure assessment(SOFA)value at the beginning of ECMO support(P<0.01).Severe neurologic complications and renal function failure requiring continuous renal replace⁃ment treatment(CRRT)in the DG were significantly higher than those in SG(P<0.01).Multivariable logistic regression analysis showed that cardiac function failure(odds ratio,2.35[95%confidence interval,1.28-3.15];P=0.025),severe neurological com⁃plications(OR,2.62[95%CI,1.35-4.27];P=0.011)and renal function failure requiring CRRT(OR,5.03;95%CI:2.14-12.49;P<0.001)were significantly associated with in-hospital mortality.Conclusion ECMO could provide hemodynamic support in elderly patients with postcardiotomy cardiogenic shock and might save lives for sometimes.