超声心动图定量参数与急性心肌梗死患者ECMO早期撤机结局的关系探讨

Correlation of echocardiographic quantitative parameters with early ECMO weaning outcomes in patients with acute myocardial infarction

目的探讨超声心动图定量参数与急性心肌梗死患者体外膜氧合器(ECMO)早期撤机结局的关系。方法回顾性分析2020年2月—2022年2月淮安市第二人民医院收治的82例采用ECMO救治的急性心肌梗死患者的临床资料。采用彩色多普勒超声诊断仪测量患者上机和撤机后的超声心动图参数,包括左室射血分数(LVEF)、二尖瓣侧壁瓣环收缩速度(Sa)、右室面积变化分数(RVFAC)和左室流出道速度-时间积分(LVOT-VTI);统计患者撤机后28 d生存情况,比较死亡患者和生存患者上机和撤机后超声心动图参数的差值;采用一般多因素Logistic回归分析影响急性心肌梗死患者ECMO早期撤机结局的因素;绘制受试者工作特征(ROC)曲线分析超声心动图定量参数对急性心肌梗死患者ECMO早期撤机结局的预测效能。结果撤机后随访28 d,82例急性心肌梗死患者有24例死亡。死亡患者的多脏器功能衰竭占比、多支血管病变占比均高于生存患者(P<0.05);死亡患者上机和撤机后LVEF差值、Sa差值、RVFAC差值、LVOT-VTI差值均低于生存患者(P<0.05);一般多因素Logistic回归分析结果显示,多脏器功能衰竭[OR=3.367(95%CI:1.073,10.562)]、LVEF[OR=3.327(95%CI:1.060,10.436)]、Sa[OR=3.476(95%CI:1.108,10.906)]、RVFAC[OR=3.721(95%CI:1.186,11.673)]、LVOT-VTI[OR=3.931(95%CI:1.253,12.333)]均是影响急性心肌梗死患者ECMO早期撤机后死亡的危险因素(P<0.05);ROC曲线分析结果显示,上机后LVEF、Sa、RVFAC、LVOT-VTI的最佳截断值分别为22.18%、5.01 cm/s、26.87%和9.93 cm,联合检测的敏感性为79.17%(95%CI:0.578,0.929)、特异性为98.28%(95%CI:0.908,1.000)、AUC为0.927(95%CI:0.847,0.973)。结论超声心动图定量参数与急性心肌梗死患者ECMO早期撤机结局有关,可作为预测患者死亡的敏感指标。

Objective To explore the correlation between echocardiographic quantitative parameters and early weaning outcomes of extracorporeal membrane oxygenerator(ECMO)in patients with acute myocardial infarction.Methods The data of 82 patients with acute myocardial infarction treated by ECMO in the hospital from February 2020 to February 2022 were retrospectively analyzed,the Color Doppler ultrasound was used to measure the echocardiographic parameters of the patients after weaning and weaning,including left ventricular ejection fraction(LVEF),mitral sidewall annular systolic velocity(Sa),and right ventricular area fractional change(RVFAC)and left ventricular outflow tract velocity-time integral(LVOT-VTI),the 28-day survival of patients after weaning was counted.The difference of echocardiographic parameters after boarding and weaning between the dead patients and the surviving patients was compared.The factors affecting the outcome of early ECMO weaning in patients with acute myocardial infarction were analyzed,the receiver operating curve(ROC)was used to analyze the value of the difference of echocardiographic parameters after boarding and weaning in predicting the outcome of early ECMO weaning in patients with acute myocardial infarction.Results During the 28-day follow-up after weaning,24 of the 82 patients with acute myocardial infarction died.The proportions of multiple organ failure and multi-vessel disease in the dead patients were higher than those in the surviving patients(P<0.05).The difference of LVEF,Sa,RVFAC,and LVOT-VTI after boarding and weaning of the dead patients were lower than those of the surviving patients(P<0.05).Logistic multivariate regression analysis showed that multiple organ failure[OR=3.367(95%CI:1.073,10.562)],LVEF[OR=3.327(95%CI:1.060,10.436)],Sa[OR=3.476(95%CI:1.108,10.906)],RVFAC[OR=3.721(95%CI:1.186,11.673)],LVOT-VTI[OR=3.931(95%CI:1.253,12.333)]after boarding were the risk factors for death after early ECMO weaning in patients with acute myocardial infarction(P<0.05).ROC analysis showed that the best cut-off points of difference of LVEF,Sa,RVFAC,and LVOT-VTI after boarding and weaning were 22.18%,5.01 cm/s,26.87%and 9.93 cm,respectively,and the combined sensitivity,specificity and AUC were 79.17%(95%CI:0.578,0.929),98.28%(95%CI:0.908,1.000),0.927(95%CI:0.847,0.973),respectively.Conclusion Quantitative echocardiographic parameters are associated with early ECMO weaning outcomes in patients with acute myocardial infarction,and it can be used as a sensitive indicator for predicting patient mortality.