冠状动脉旁路移植术后重症患者体外膜氧合辅助时间与预后的相关性分析

The relationship between duration of venoarterial extracorporeal membrane oxygenation and outcome in critical patients after coronary artery bypass grafting

目的:分析冠状动脉旁路移植术(CABG)后重症患者体外膜氧合(ECMO)辅助时间与住院死亡的关系。方法:回顾性分析148例北京安贞医院心脏外科危重症中心,2010年1月至2017年12月,应用静脉-动脉体外膜氧合(VA-ECMO)的CABG术后重症患者。用Logistic回归分析ECMO辅助时间与患者住院死亡的关系。结果:148例患者中92例(62.2%)成功脱离ECMO,66例(44.6%)顺利出院。ECMO辅助中位时间为4(3,6)d。与ECMO辅助时间<3 d或≥7 d的患者相比,ECMO辅助时间为3~6 d的患者住院死亡率最低(40.4%vs.87.5%,P<0.001;40.4%vs.72.7%,P=0.003)。调整女性、左主干病变、SOFA评分及血清乳酸后,以ECMO辅助时间3-6 d为参照,ECMO辅助时间<3 d、≥7 d的OR值分别为5.72(95%CI:1.62~20.23)、6.98(95%CI:1.46~33.23)。结论:CABG术后重症患者ECMO辅助时间<3 d或≥7 d是患者住院死亡的风险因素,但ECMO治疗时间的长短还取决于患者潜在疾病的影响。

Objective:The objective of this study was to investigate the relationship between venoarte-rial extracorporeal membrane oxygenation(VA-ECMO)duration and in-hospital mortality in coronary artery by-pass grafting(CABG)patients.Methods:We included 148 CABG patients supported with VA-ECMO at Bei-jing Anzhen Hospital between January 2010 and December 2017.Multivariable logistic regression analysis was performed to assess the relationship between VA-ECMO duration and in-hospital mortality,and adjust for poten-tial confounding variables.Results:Of 148 CABG patients treated with VA-ECMO,92(62.2%)patients were weaned from VA-ECMO,and 66 patients(44.6%)survived to hospital discharge.The median time on VA-EC-MO support were 4(3,6)days.Patients who used ECMO for 3-6 days had significantly lower mortality than those who used ECMO for<3 days(40.4%vs.87.5%,P<0.001)or≥7 days(40.4%vs.72.7%,P=0.003).After adjusting for age,left main disease,SOFA score,and serum lactate,ECMO duration<3 days and≥7 days were associated with an increased risk of in-hospital mortality.Conclusions:ECMO duration<3 days and≥7 days in patients after CABG were associated with an increased risk of in-hospital mortality,but du-ration of VA-ECMO treatment that is required and is sustainable depends on the underlying disease process.