体外膜肺氧合治疗呼吸循环衰竭的输血情况及预后影响因素分析

Blood transfusion and prognostic factors of extracorporeal membrane pulmonary oxygenation for the treatment of respiratory and circulatory failure

目的分析体外膜肺氧合(ECMO)治疗呼吸循环衰竭的输血情况及预后影响因素。方法回顾性分析黄石市中心医院2016年3月至2021年7月治疗的呼吸循环衰竭患者80例的临床资料,根据28 d的预后情况分为死亡组(n=44)和存活组(n=36),比较两组患者的一般资料、ECMO治疗期间的输血情况、生命体征、实验室指标、通气时间、住院时间,分析ECMO治疗呼吸循环衰竭死亡的影响因素。结果死亡组与存活组患者性别、年龄、体质量、并发症发生情况、呼吸循环衰竭病因、ECMO治疗方式等差异均无统计学意义(均P>0.05);存活组术前急性生理学和慢性健康状况Ⅱ(APACHEⅡ)评分、肌酐(Cr)、降钙素原(PCT)、乳酸(Lac)分别为(22.36±3.71)分、(79.17±9.29)μmol/L、(2.77±0.79)ng/L、(2.74±0.36)mmol/L,均低于死亡组的(34.27±4.98)分、(94.16±10.23)μmol/L、(3.69±1.10)ng/L、(5.18±0.42)mmol/L,差异均有统计学意义(t=-11.89、-6.79、-5.62、-27.53,均P<0.001);两组术前呼吸频率、舒张压、收缩压、心率、氧合指数(PaO2/FiO2)、C反应蛋白(CRP)差异均无统计学意义(均P>0.05);存活组上机当天输血量、下机当天输血量、全程输血量、通气时长、ECMO并发症发生率分别为(98.74±16.28)mL、(37.23±10.36)mL、(398.79±67.81)mL、(210.39±20.21)h、38.89%(14/36),均低于死亡组的(160.17±23.14)mL、(48.26±12.25)mL、(600.23±70.12)mL、(320.14±18.21)h、79.55%(35/44),差异均有统计学意义(t=-13.43、-4.29、4.94、25.25,χ^(2)=13.79,均P<0.001);存活组住院时间[(20.14±5.36)d)]长于死亡组[(14.17±4.23)d](t=5.56,P<0.001);APACHEⅡ评分、PCT、上机当天输血量、通气时间、全程输血量等是ECMO治疗死亡的危险因素,而住院时间是ECMO的保护因素。结论术前APACHEⅡ评分评估、全程持续性输血、把握通气时机和注意预防ECMO治疗并发症是提高患者生存率的关键。

Objective To analyze blood transfusion and prognostic factors of extracorporeal membrane pulmonary oxygenation(ECMO)for the treatment of respiratory and circulatory failure.Methods The clinical data of 80 patients with respiratory and circulatory failure who received treatment in Huangshi Central Hospital from March 2016 to July 2021 were retrospectively analyzed.According to 28-day prognosis,these patients were divided into death group(n=44)and survival group(n=36).The general data,blood transfusion during the process of ECMO,vital signs,laboratory indicators,ventilation time,and length of hospital stay were compared between the two groups.The factors affecting death during the process of ECMO were analyzed.Results There were no significant differences in sex,age,body mass index,complications,the cause of respiratory and circulatory failure,and the mode of ECMO between the two groups(all P>0.05).Preoperative Acute Physiology and Chronic Health Evaluation II score,creatinine,procalcitonin and lactic acid levels in the survival group were(22.36±3.71)points,(79.17±9.29)μmol/L,(2.77±0.79)ng/L,(2.74±0.36)mmol/L,respectively,which were significantly lower than(34.27±4.98)points,(94.16±10.23)μmol/L,(3.69±1.10)ng/L,(5.18±0.42)mmol/L,respectively in the death group(t=-11.89,-6.79,-5.62,-27.53,all P<0.001).There were no significant differences in preoperative respiratory frequency,diastolic pressure,systolic pressure,heart rate,oxygenation index(PaO2/FiO2)and C-reactive protein between the two groups(all P>0.05).The volume of blood transfused on the day of undergoing ECMO,the volume of blood transfused on the day of withdrawing ECMO,the volume of blood transfused during the whole process of ECMO,duration of ventilation,and the incidence of complications related to ECMO were(98.74±16.28)mL,(37.23±10.36)mL,(398.79±67.81)mL,(210.39±20.21)hours,38.89%(14/36),respectively,which were significantly lower than(160.17±23.14)mL,(48.26±12.25)mL,(600.23±70.12)mL,(320.14±18.21)hours,79.55%(35/44),respectively in the death group(t=-13.43,-4.29,4.94,25.25,χ^(2)=13.79,all P<0.001).The length of hospital stay in the survival group was longer than that in the death group[(20.14±5.36)days vs.(14.17±4.23)days,t=5.56,P<0.001).Acute Physiology and Chronic Health Evaluation II score,procalcition level,the volume of blood transfused on the day of ECMO,duration of ventilation,and the volume of blood transfused during the whole process of ECMO are risk factors for death after ECMO,while length of hospital stay is a protective factor for ECMO.Conclusion Preoperative evaluation of Acute Physiology and Chronic Health Evaluation II score,continuous blood transfusion during the whole process of ECMO,grasping the opportunity of ventilation and preventing against complications of ECMO are the keys to increasing the survival rate of patients with respiratory and circulatory failure.