心脏术后心源性休克行体外膜肺氧合辅助后血液相容性不良事件的影响因素分析

Factors influencing the hemocompatibility related clinical adverse events after ECMO implantation in postcardiotomy cardiogenic shock patients

目的:探索心脏术后心源性休克行体外膜肺氧合辅助(ECMO)植入术后患者发生血液相容性不良事件(HRAEs)的特点及其影响因素。方法:回顾性分析2008年4月至2018年12月在北京阜外医院行心脏手术后发生心源性休克接受ECMO植入的280例患者,根据是否发生HRAEs分为HRAEs组(n=27)与对照组(n=253)。以血液相容性评分来确定HRAEs,采用Mann-Whitney U检验进行组间比较,用COX回归分析对ECMO植入术后患者HRAEs的影响因素进行分析。结果:与对照组相比,HRAEs组患者的年龄、平均住院天数、体质量指数、术前高血压状态的患者比例、术前合并右心功能不全的患者比例更高(P均<0.05),平均动脉压较低(P<0.05)。多因素COX回归分析显示,ECMO植入术前存在缺血性疾病(HR=5.303,95%CI:1.622~17.339,P=0.006)和心房颤动(房颤)(HR=3.911,95%CI:1.168~13.103,P=0.027)是HRAEs的独立危险因素,而术后患者的平均动脉压较高(HR=0.427,95%CI:0.332~0.549,P<0.001),是HRAEs的保护因素。ECMO植入术前存在缺血性疾病的患者血液相容性评分Ⅰ级和ⅢA级的分值更高(P=0.012,0.022);植入术前有房颤的患者血液相容性评分Ⅰ级和ⅢB级的分值更高(P=0.010,P<0.001)。结论:ECMO植入术前存在缺血性疾病、房颤是心脏术后心源性休克行ECMO辅助的成人患者发生HRAEs的危险因素。

Objective:To explore the related factors of hemocompatibility-related clinical adverse events(HRAEs)after extra-corporeal membrane oxygenation(ECMO)implantation in postcardiotomy cardiogenic shock(PCS)patients.Methods:A total of 280 PCS patients using ECMO devices from April 2008 to December 2018 in Fuwai Hospital were enrolled.They were divided into HRAEs group(n=27)and control group(n=253)based on whether or not HRAEs occurred.The baseline characteristics,complications and medical therapies were compared between the two groups.HRAE was identified by the hemocompatibility score(HCS).The difference between the two groups was analyzed by Mann-Whitney U test.And multiple COX regression analysis was used to explore the related factors of HRAEs after ECMO implantation in PCS patients.Results:Compared with the control group,patients in the HRAEs group were older,with higher body mass index(BMI)and lower mean arterial pressure(MAP)(all P<0.05).The rates of patients with hypertension and right ventricular dysfunction in HRAEs group were higher(both P<0.05).Patients in the HRAEs group had a longer hospital stay(P<0.05).The COX regression analysis showed that ischemic disease(HR=5.303,95%CI 1.622-17.339,P=0.006)and atrial fibrillation(HR=3.911,95%CI 1.168-13.103,P=0.027)were independent factors of HRAEs,while higher MAP after operation(HR=0.427,95%CI 0.332-0.549,P<0.001)was an independent protective factor.The patients with ischemic disease had a higher HCS score of levelⅠandⅢA(P=0.012,P=0.022).The patients with atrial fibrillation had a higher HCS score of levelⅠandⅢB(P=0.010,P<0.001).Conclusions:Ischemic disease and atrial fibrillation are independent risk factors of HRAEs after ECMO implantation in PCS,and controlling these risk factors could reduce the incidence of HRAE.