限制性氧疗对VA-ECMO患者肾损伤及预后的影响

目的探讨限制性氧疗对静脉-动脉体外膜肺氧合(VA-ECMO)治疗患者肾损伤及预后的影响.方法选择2018年1月至2020年12月实施VA-ECMO治疗的患者30例,分为对照组与观察组,各15例.对照组患者常规给予ECMO初始100%氧浓度,观察组患者在不改变ECMO转速、流量及氧流量的基础上,进行限制性给氧,ECMO初始氧浓度调整为40%,维持患者指尖血氧饱和度>95%,氧分压波动在70~190 mmHg.记录两组患者ECMO上机前、ECMO上机后6 h、24 h、48 h膜后血气指标酸碱度(pH)、血氧分压(PaO2)、肾脏标志物血清肌酐(SCr)、尿素氮(UN)、肾脏替代疗法(RRT)使用情况、机械通气(MV)时间、ECMO支持时间及14 d死亡率.结果两组患者膜后血气分析指标比较,PH值在上机前、上机后6 h、24 h及48 h差异无统计学意义(P>0.05),PaO2上机前差异无统计学意义(P>0.05),上机后6 h、24 h及48 h差异有统计学意义(P<0.05).两组患者肾脏生物标志物指标比较,SCr、UN上机前,上机后6 h、24 h差异无统计学意义(P>0.05),上机后48 h差异有统计学意义(P<0.05).观察组MV、ECMO支持时间及RRT使用率与对照组比较,差异有统计学意义(P<0.05);但两组患者14 d死亡率差异无统计学意义(P>0.05).结论对VA-ECMO治疗患者实行限制性氧疗,能早期预防肾功能的损伤,降低肾功能衰竭发生率,明显减少患者有创支持时间,值得临床推广应用.

Objective To explore the efiet of rsrcive oxygen therapy on renal injury and prognosis of patients treated with VA-ECMO.Methods A prospective conrolled study was conducted.The subjects of the study included patients who were treated with VA-ECMO in our hospital from January 2018 to Deccember 2020.There were 15 cases in the control group and 15 cases in the experimental group.Patients in the control group were routinely given the initial 100%oxygen concentration of ECMO.The patients in the experimental group were given restricted oxygen without changing the ECMO speed,flow,and oxygen flow.The initial ECMO oxygen concentration was adjusted to 40%,the blood oxygen saturation of the patient's fingertips was maintained above 95%,and the oxygen partial pressre fluctuated at 70-190 mmHg.Blood gas indicators(pH,PaO_(2)),kidney markers(SCr,UN),RRT usage,mechanical ventilation(MV)Time,ECMO support time and 14-day mortality rate were recorded before ECMO on the machine,6 h after ECMO on the machine,24 h after ECMO on the machine,and 48 h after ECMO on the machine both of the two groups of patients.Results The comparison of the indicators of the retro-membrane blood gas analysis of the two groups of patients showed that the PH between the:two groups of patients before,6 h,24 h and 48 h after the machine were not statistically significant(P>0.05),the PaO_(2) had no significant difference before the computer(P>0.05),and the difference at 6 h、24 h and 48 h were stitially significant(P<0.05).There was no significant difference in renal biomarkers SCr and UN between the two groups of patients before they were put on the machine,6 hours and 24 hours after they were put on the machine(P>0.05).The difference was stistically significant at 48 h after the patients were on the machine(P<0.05).The MV support time,ECMO support time and RRT use rate increased in the two groups of patients,and the diference was stitially signifcant(P<0.05).However,there was no stisticallyl significant diference in 14-day mortality between the twa groups(P>0.05).Conclusion By monitoring renal markers,restrictive oxygen therapy for patients treated with VA-ECMO can prevent renal function damage early,reduce the incidence of renal failure and significantly reduce the patient's invasive support time.It is worthy of clinical application.