红细胞分布宽度与血小板分布宽度对体外膜肺氧合支持的急性心肌梗死患者预后的判断

The study of red blood cell distribution width and platelet distribution width on the prognosis of patients with acute myocardial infarction treated by extracorporeal membrane oxygenation

目的探讨在体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)上机初期,红细胞分布宽度(red blood cell volume distribution width,RDW)和血小板分布宽度(platelet distribution width,PDW)对急性心肌梗死患者预后的判断价值。方法回顾性分析2017年4月至2021年7月期间接受静脉-动脉体外膜肺氧合(veno-arterial extracorporeal membrane oxygenation,VA-ECMO)治疗的急性心肌梗死患者。比较不同预后患者一般情况、ECMO上机前APACHEⅡ评分、治疗期间最高的氨基末端脑钠尿肽前体(N-terminal fragment of the brain natriuretic peptide precursor,NT-proBNP)和肌钙蛋白T数值。ECMO运行后即刻监测的血红蛋白、RDW、血小板计数、PDW和平均血小板体积。并记录同时期采血检测的活化部分凝血酶原时间。比较不同预后组上述指标的差异,并采用Logistic回归分析与预后的相关性。结果入选55例,存活18例(32.8%),平均年龄(54.7±11.2)岁,其中男性48例(87.3%)。存活组上机前前APACHEⅡ评分低于死亡组(分:26.00±6.54 vs.30.54±4.35,P<0.05)。存活组RDW低于死亡组(%:12.57±0.60 vs.128.59±0.80);PDW在两组间差异无统计学意义(P>0.05)。Logistic回归分析显示,上机前APACHEⅡ评分与患者预后相关,而RDW与患者预后不相关。结论VA-ECMO支持的急性心肌梗死患者上机前APACHEⅡ评分可以预测患者预后,而RDW和PDW不适合作为患者预后判断指标。

Objective To investigate the prognostic value of red blood cell distribution width(RDW)and platelet distribution width(PDW)in the patients with acute myocardial infarction at the early stage of extracorporeal membrane oxygenation(ECMO).Methods To retrospectively analyze the patients with acute myocardial infarction treated with veno-arterial extracorporeal membrane oxygenation(VA-ECMO)from April 2017 to July 2021.The general conditions of the patients with different prognosis,APACHEⅡbefore ECMO operation,the highest N-terminal fragment of the brain natriuretic peptide precursor(NT-proBNP)and troponin T during the treatment;hemoglobin,RDW,platelet count,PDW,average platelet volume monitored immediately after ECMO operation,and activated partial prothrombin time were compared.The differences of the above indexes in different prognostic groups and their prognostic value were compared.Results 55 patients were enrolled,18 patients survived(32.8%),the average age was(54.7±11.2)years old,of which 48 patients were male,accounting for 87.3%.Before VA-ECMO,the APACHEⅡscore of the survival group was lower than that of the death group(score:26.00±6.54 vs.30.54±4.35,P<0.05);the RDW of the survival group was lower than that of the death group(%:12.57±0.60 vs.128.59±0.80);there were no statistical differences in PDW between the two groups(P>0.05).Logistic regression analysis showed that APACHEⅡscore before VA-ECMO was correlated with the prognosis of patients,while RDW was not correlated with the prognosis of patients.Further analysis was carried out on the APACHE II score before the machine and the prognosis of the patients,while the RDW was not related to the prognosis of the patients.Conclusion For the patients with acute myocardial infarction treated by VA-ECMO,APACHEⅡscore can predict the prognosis of patients before VA-ECMO,while RDW and PDW are not suitable as prognostic indicators.