左心室功能参数监测经静脉-动脉体外膜肺氧合辅助患者心功能

Left ventricular function parameters for monitoring cardiac function in patients assisted by venous-arterial extracorporeal membrane oxygenation

目的观察超声心动图监测经静脉-动脉模式体外膜肺氧合(V-A ECMO)辅助患者左心室功能参数变化及预测脱机的价值。方法回顾性分析18例接受V-A ECMO辅助治疗患者,根据脱机成功与否分为成功组12例、失败组6例;对比2组ECMO支持第1天、脱机前1天及脱机即刻左心室舒张末期容积(LVEDV)、收缩末期容积(LVESV)、左心室射血分数(LVEF)、左心室流出道速度-时间积分(VTI)、主动脉瓣最大前向血流速度(AV-V_(max))、二尖瓣口舒张早期峰值血流速度(E)、收缩期二尖瓣环侧壁位点运动速度(TDI lat s')及舒张早期二尖瓣环间隔壁位点运动速度(e'),计算E/e';采用二维斑点追踪成像获取左心室整体纵向应变(LVGLS)及应变率(LVGLSR)。结果脱机前1天,成功组LVEF、TDI lat s'、AV-V_(max)、VTI、LVGLS及LVGLSR均明显高于失败组(P均<0.05),ECMO流量明显低于失败组(P<0.05)。成功组脱机前1天LVEF、TDI lat s'、AV-V_(max)、VTI、LVGLS及LVGLSR均显著高于、ECMO流量低于ECMO支持第1天(P均<0.05);脱机即刻LVEF、TDI lat s'、VTI及LVGLS较脱机前1天进一步增高(P均<0.05)。脱机前1天,LVEF、TDI lat s'、AV-V_(max)、VTI和LVGLS预测成功脱机的AUC分别为0.926、0.917、0.861、0.944和0.981,截值分别为34.50%、9.40 cm、5.50 cm/s、-6.75%和85.00 cm/s时,敏感度分别为88.90%、88.90%、77.80%、100%和88.90%,特异度分别为83.30%、83.30%、83.30%、83.30%和100%。结论超声心动图可实时监测接受ECMO支持患者,对评估ECMO疗效、选择脱机时机及预测预后具有重要价值。

Objective To observe the value of echocardiography in monitoring changes of left ventricular function parameters and predicting weaning in patients assisted by veno-arterial extracorporeal membrane oxygenation(V-A ECMO).Methods Data of 18 patients receiving V-A ECMO adjuvant therapy were retrospectively analyzed.According to whether the weaning was successful or not,the patients were divided into successful group(n=12)and failed group(n=6).The left ventricular end-diastolic volume(LVEDV),end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),velocity time integral(VTI)of left ventricular outflow tract,maximum forward flow velocity of aortic valve(AV-V_(max)),early peak mitral orifice diastolic flow velocity(E),tissue Doppler imaging mitral latera annular systolic velocity(TDI lat s')and early diastolic septum wall site of mitral annular velocity(e')acquired on the first day of ECMO support,the day before weaning and immediately after weaning were compared between groups,and E/e'was calculated.The left ventricular global longitudinal strain(LVGLS)and strain rate(LVGLSR)were measured with two-dimensional speckle tracking imaging.Results On the day before weaning,LVEF,TDI lat s',AV-V_(max),VTI,LVGLS and LVGLSR in successful group were all significantly higher than those in failure group(all P<0.05),while the ECMO flow in successful group was significantly lower than t in failure group(P<0.05).LVEF,TDI lat s',AV-V_(max),VTI,LVGLS and LVGLSR of successful group on the day before weaning were significantly higher,but ECMO flow was lower than on the first day of ECMO support(all P<0.05).Immediately after weaning,LVEF,TDI lat s',VTI and LVGLS further increased compared with those on the day before weaning(all P<0.05).The area under the curve(AUC)of successful weaning predicted by LVEF,TDI lat s',AV-V_(max),VTI and LVGLS on the one day before weaning was 0.926,0.917,0.861,0.944 and 0.981,respectively.Taken 34.50%,9.40 cm,5.50 cm/s,-6.75%and 85.00 cm/s as cut-off values,the sensitivity was 88.90%,88.90%,77.80%,100%and 88.90%,and specificity was 83.30%,83.30%,83.30%,83.30%and 100%,respectively.Conclusion Echocardiography could real-time monitor patients receiving ECMO support,having important value for evaluating the efficacy of ECMO,selecting weaning time and predicting prognosis.