静脉-动脉体外膜氧合辅助心源性休克的危险因素分析:一项连续5年的回顾性分析

Ris factors of veno-arterial extracorporeal membrane oxygenation in treating cardiogenic shock:A consecutive 5-year retrospective study

目的 探讨心源性休克患者应用静脉-动脉体外膜氧合(VA-ECMO)辅助治疗中的危险因素。方法 回顾分析2016年1月至2021年1月5年内西安交通大学第一附属医院心血管外科ECMO中心收治的心源性休克应用VA-ECMO辅助治疗患者,根据临床结局分为康复组和死亡组,记录并比较入选病例的基本资料、临床资料以及ECMO相关参数,将具有临床意义和单因素分析中差异有统计学意义的指标与临床结局进行多因素logistic回归分析,确定危险因素。结果 最终共77例患者纳入分析,康复组35例,死亡组42例。与康复组相比,死亡组年龄更高,序贯器官衰竭评分(SOFA评分)更高,连续性血液净化治疗(CRRT)及主动脉内球囊反搏(IABP)运用比例亦更高。ECMO辅助前血小板计数比康复组更低,肌酐、尿素及乳酸更高。通过单因素分析两组患者年龄、SOFA评分、CRRT及IABP使用、N-端脑利钠肽前体、血小板、肌酐、尿素、乳酸等差异均有统计学意义。构建多因素logistic回归分析方程得出年龄和辅助前血小板计数是独立危险因素,年龄越大(OR=1.068,95%CI:1.027~1.110)、辅助前血小板越低死亡风险越高(OR=0.991,95%CI:0.984~0.998)。结论 VA-ECMO是心源性休克患者重要的机械辅助方法,高龄、基础心功能差、低血小板、合并肾功能不全、需应用IABP和(或)CRRT的患者预后不良。其中低血小板是独立危险因素,提高VA-ECMO辅助前血小板计数有可能成为今后改善预后的一个靶点。

Objective To explore the risk factors of veno-arterial extracorporeal membrane oxygenation(V-A ECMO)in treating cardiogenic shock.Methods The data of patients with cardiogenic shock treated with V-A ECMO in the Department of Cardiovascular Surgery,First Affiliated Hospital of Xi′an Jiaotong University from January 2016 to January 2021 were retrospectively analyzed.The patients were divided into the rehabilitation group and the death group according to their prognosis and the baseline data,and their clinical data and ECMO related parameters were recorded.The parameters with clinical significance and significant difference in univariate analysis were analyzed by multivariate Logistic regression analysis to investigate the risk factors of V-A ECMO in treating the cardiogenic shock.Results A total of 77 patients were enrolled in the study,with 35 in the rehabilitation group and 42 in the death group.Compared with the rehabilitation group,the age,SOFA score,rates of CRRT and IABP were higher in the death group.Before VA-ECMO,the PLT counts were lower and the levels of Cr,BUN and lactate were higher in the death group,as compared with the rehabilitation group.By univariate Logistic regression analysis,there were significant differences in age and score of SOFA,use of CRRT and IABP,NT-proBNP,platelet,creatinine,urea and lactic acid.By multivariate Logistic regression analysis,the independent prognostic risk factors for the patients′death were age and pre-ECMO platelet count.The higher the age(OR=1.068,95%CI:1.027~1.110)was and the lower the pre-ECMO platelet counts(OR=0.991,95%CI:0.984~0.998)were,the higher the death risk.ConclusionVA-ECMO is an important mechanical therapy for patients with cardiogenic shock.The patients with advanced age,worse cardiac function,low PLT counts,renal insufficiency,use of IABP and/or CRRT may come out with poor prognosis.Lower platelet count is independent risk factor for the dearth,so increased platelet counts may be a target for improving prognosis of the cardiogenic shock patients undergoing VA-ECMO.