体外膜肺氧合对心脏骤停患者神经功能预后的影响

Effect of extracorporeal membrane oxygenation on the prognosis of neurological function in patients with cardiac arrest

目的探讨体外膜肺氧合(ECMO)对心脏骤停患者神经功能预后的影响因素。方法纳入2012年1月至2020年6月因心脏骤停入住浙江大学医学院附属杭州市第一人民医院重症医学科且行ECMO治疗的22例患者。以脑功能分类(CPC)量表评价患者出院时神经功能情况,并将其分为CPC良好组(12例,CPC 1~2分)和CPC不佳组(10例,CPC 3~5分)。比较两组患者的一般资料、心脏骤停病因、基础疾病、疾病严重程度、心脏骤停相关情况、神经系统相关情况、ECMO相关情况及肌钙蛋白I、白蛋白等生化指标。采用二分类Logistic回归分析ECMO治疗心脏骤停患者对其神经功能预后的影响因素。结果22例接受ECMO治疗的心脏骤停患者中,14例存活出院且12例神经功能良好。CPC不佳组患者肌钙蛋白I[47.0(26.8,80.0)μg/L vs.13.6(3.3,32.6)μg/L,U=20.000,P=0.017]水平较CPC良好组显著升高,白蛋白[(27±7)g/L vs.(33±6)g/L,t=2.485,P=0.022]水平较CPC良好组显著降低。此外,CPC不佳组患者第3天ECMO流量[(3.6±0.8)L/min vs.(3.0±0.7)L/min,t=2.091,P=0.050]高于CPC良好组,但两组比较差异无统计学意义。Logistic回归分析结果显示,较低的白蛋白浓度[优势比(OR)=0.755,95%置信区间(CI)(0.576,0.990),P=0.042]是ECMO治疗心脏骤停患者神经功能预后不佳的独立危险因素。结论较低的白蛋白浓度是ECMO治疗的心脏骤停患者神经功能预后不佳的独立危险因素。

Objective To explore the influencing factors of extracorporeal membrane oxygenation(ECMO)on the prognosis of neurological function in patients with cardiac arrest(CA).Methods A total of 22 patients with CA who were treated with ECMO in the Department of Intensive Care Unit,the Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine from January 2012 to June 2020 were included.After evaluating the cerebral performance category(CPC)scale at discharge,we divided the participants into two groups:12 cases in the good CPC group(CPC 1-2)and 10 cases in the poor CPC group(CPC 3-5).The general information,causes of CA,underlying diseases,disease severity,CA related conditions,nervous system related conditions,ECMO related conditions,troponin I,albumin and other biochemical indicators were compared between the two groups.Then with binary Logistic regression analysis,we assessed the possible influencing factors of ECMO on the prognosis of neurological function in participants.Results Of the 22 CA patients treated with ECMO,14 were alive at discharge and among them 12 were alive with good neurological function.The poor CPC group has a significantly higher level of troponin I[47.0(26.8,80.0)μg/L vs.13.6(3.3,32.6)μg/L,U=20.000,P=0.017],and a lower level of albumin[(27±7)g/L vs.(33±6)g/L,t=2.485,P=0.022]comparing with the good CPC group.Though the flow rate on the third day of ECMO was higher in the poor CPC group,there was no statistically significant difference between two groups[(3.6±0.8)L/min vs.(3.0±0.7)L/min,t=2.091,P=0.050].In addition,the Logistic regression analysis showed that lower albumin concentration was an independent risk factor for poor neurological prognosis in patients with CA after ECMO treatment[odds ratio(OR)=0.755,95%confidence interval(CI)(0.576,0.990),P=0.042].Conclusion In present study,we found lower albumin concentration was an independent risk factor for poor neurological prognosis in patients with CA after ECMO treatment.