ECMO治疗对心源性休克患者早期乳酸清除率及经皮氧分压监测的临床意义

Clinical Significance of ECMO Treatment for Early Lactate Clearance and Percutaneous Partial Oxygen Pressure Monitoring in Patients with Cardiogenic Shock

目的:研究体外膜肺氧合(ECMO)治疗对心源性休克患者早期乳酸清除率及经皮氧分压监测的临床意义。方法:回顾性分析2015年10月-2020年8月于本院接受ECMO治疗的心源性休克患者79例的资料,根据ECMO撤离后28 d内患者生存情况分为死亡组(37例)和非死亡组(42例),比较两组患者ECMO治疗前(T_(1))、治疗3 h后(T_(2))、治疗6 h后(T_(3))的乳酸清除率和经皮氧分压监测结果,并分析其与病情严重程度的关系及对患者预后的预测价值。结果:死亡组患者入院时初始血乳酸值和T_(1)、T_(2)、T_(3)的急性生理和慢性健康状况(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分均高于非死亡组,差异均有统计学意义(P<0.05)。死亡组患者T_(2)、T_(3)乳酸清除率均低于非死亡组,且死亡组患者乳酸清除率T_(2)>T_(1)>T_(3),两两比较,差异均有统计学意义(P<0.05)。死亡组患者T_(2)、T_(3)经皮氧分压均低于非死亡组,且死亡组患者经皮氧分压T_(3)<T_(2)<T_(1),差异均有统计学意义(P<0.05)。Pearson相关性分析显示,T_(2)、T_(3)的乳酸清除率、经皮氧分压与APACHEⅡ评分、SOFA评分均呈负相关(P<0.05)。ECMO治疗3、6 h后乳酸清除率、经皮氧分压均可预测心源性休克患者28 d死亡率,其ROC曲线下面积均>0.7;其中以ECMO治疗6 h后乳酸清除率、经皮氧分压预测能力更佳(P<0.05)。结论:心源性休克患者乳酸清除率及经皮氧分压监测可评估病情严重程度及疾病进展情况,对预测ECMO治疗的预后有一定价值,建议临床密切监测。

Objective:To investigate the clinical significance of extracorporal membrane oxygenation (ECMO) for early lactate clearance and percutaneous partial oxygen pressure monitoring in patients with cardiogenic shock.Method:The data of 79 patients with cardiogenic shock who received ECMO treatment in our hospital from October 2015 to August 2020 were retrospectively analyzed.According to the survival status of patients within 28 d after ECMO withdrawal,they were divided into death group (37 cases) and non-death group (42 cases).Lactate clearance rate and percutaneous oxygen partial pressure monitoring results were compared between the two groups before ECMO treatment (T_(1)),after ECMO treatment for 3 h (T_(2)),and after ECMO treatment for 6 h (T_(3)),the relationship between the disease severity and prognosis was analyzed.Result:The initial blood lactic acid value,acute physiological and chronic health status (APACHEⅡ) score and sequential organ failure (SOFA) score of T_(1),T_(2) and T_(3) in the death group were higher than those in the non-death group,the differences were statistically significant (P<0.05).The lactate clearance rates of T2 and T3 in the death group were lower than those in the non-death group,and the lactate clearance rate of the death group was T_(2)>T_(1)>T_(3),the differences were statistically significant (P<0.05).Pearson correlation analysis showed that lactate clearance rate and percutaneous oxygen partial pressure at T2 and T3 were negatively correlated with APACHEⅡ score and SOFA score (P<0.05).Pearson correlation analysis showed that the lactic acid clearance rate and percutaneous partial oxygen pressure of T2 and T_(3) were negatively correlated with APACHEⅡ score and SOFA score (P<0.05).Both the lactate clearance rate and percutaneous partial oxygen pressure after 3 and 6 h of ECMO treatment could predict the 28 d mortality of patients with cardiogenic shock,and the area under the ROC curve was all >0.7;among them,the prediction ability of Lactic acid clearance rate and percutaneous partial oxygen pressure after 6 h treatment with ECMO was better (P<0.05).Conclusion:Lactate clearance rate and transcutaneous oxygen partial pressure monitoring in patients with cardiogenic shock can evaluate the severity and progression of the disease,and have certain value in predicting the prognosis of ECMO treatment,it is suggested that clinical close monitoring should be carried out.