体外膜肺氧合治疗呼吸衰竭的效果及预后分析

Effect and prognosis of extracorporeal membrane oxygenation in the treatment of respiratory failure

目的探讨体外膜肺氧合(ECMO)治疗呼吸衰竭的效果及预后。方法本研究为回顾性研究。选取2019年5月至2022年6月黄石市中心医院诊治的84例呼吸衰竭患者作为研究对象,按照治疗方法分为观察组(予以ECMO治疗)与对照组(予以有创正压机械通气治疗)各42例。观察组中,男性21例、女性21例,年龄(55.82±2.41)岁;对照组中,男性22例、女性20例,年龄(55.62±2.36)岁。对比两组气道阻力(RAW)、气道峰压(P_(peak))、静态顺应性(Cst)、脉搏血氧饱和度(SpO_(2))、动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))、第1秒用力呼气容积(FEV_(1))、第1秒用力呼气容积占用力肺活量的百分比(FEV_(1)/FVC)、最大呼气流量(PEF)、内皮素-1(ET-1)、Clara细胞分泌蛋白16(CC16)、和肽素(Copeptin)、28 d病死率、撤机成功率、通气时间。采用独立样本t检验、χ^(2)检验。结果治疗前,两组RAW、Cst、P_(peak)、SpO_(2)、PaCO_(2)、PaO_(2)、FEV_(1)、FEV_(1)/FVC、ET-1、CC16、Copeptin比较,差异均无统计学意义(均P>0.05)。治疗后,观察组的RAW、Cst、PaCO_(2)、ET-1、CC16、Copeptin分别为(16.42±1.78)cmH_(2)O/L•s(1 cmH_(2)O=0.098 kPa)、(27.41±5.62)cmH_(2)O、(50.01±6.32)mmHg(1 mmHg=0.133 kPa)、(14.21±2.32)ng/L、(0.18±0.03)ng/L、(28.62±6.85)ng/L,显著低于对照组的(18.05±2.36)cmH_(2)O/L•s、(25.05±4.11)cmH_(2)O、(53.85±8.47)mmHg、(26.65±3.96)ng/L、(0.29±0.08)ng/L、(35.74±9.52)ng/L(均P<0.05);观察组P_(peak)、SpO_(2)、PaO_(2)、FEV_(1)、FEV_(1)/FVC、PEF分别为(14.65±1.44)cmH_(2)O、(96.45±17.05)%、(70.52±8.96)mmHg、(61.25±8.45)%、(68.74±9.45)%、(4.89±0.56)L/s,显著高于对照组的(16.05±1.96)cmH_(2)O、(94.11±15.14)%、(68.01±6.85)%、(48.33±6.45)%、(59.78±6.08)%、(4.24±0.39)L/s(均P<0.05)。观察组的28 d病死率9.52%(4/42)低于对照组28.57%(12/42),通气时间(9.52±2.32)d短于对照组(11.36±3.69)d,撤机成功率95.24%(40/42)高于对照组73.81%(31/42)(均P<0.05)。结论ECMO治疗呼吸衰竭具有较为理想效果,有利于改善血气分析指标和降低病死率。

Objective To investigate the effect and prognosis of extracorporeal membrane oxygenation(ECMO)in the treatment of respiratory failure.Methods This study was a retrospective study.A total of 84 respiratory failure patients diagnosed and treated in Huangshi Central Hospital from May 2019 to June 2022 were selected as the research objects.According to treatment methods,they were divided into an observation group(receiving ECMO treatment)and a control group(receiving invasive positive pressure mechanical ventilation treatment),with 42 cases in each group.In the observation group,there were 21 males and 21 females,aged(55.82±2.41)years;in the control group,there were 22 males and 20 females,aged(55.62±2.36)years.The airway resistance(RAW),airway peak pressure(P_(peak)),static compliance(Cst),surplus pulse O_(2)(SpO_(2)),partial pressure of arterial carbon dioxide(PaCO_(2)),partial pressure of arterial oxygen(PaO_(2)),forced expiratory volume in 1 second(FEV_(1)),percentage of forced expiratory volume in 1 second to forced vital capacity(FEV_(1)/FVC),peak expiratory flow(PEF),endothelin(ET-1),Clara cell secretion protein 16(CC16),Copeptin,28 d mortality,withdrawal success rate,and ventilation time were compared between the two groups.Independent sample t test andχ^(2)test were performed.Results Before treatment,there were no statistically significant differences in the RAW,Cst,P_(peak),SpO_(2),PaCO_(2),PaO_(2),FEV_(1),FEV_(1)/FVC,ET-1,CC16,and Copeptin between the two groups(all P>0.05).After treatment,the RAW,Cst,PaCO_(2),ET-1,CC16,and Copeptin of the observation group were(16.42±1.78)cmH_(2)O/L•s(1 cmH_(2)O=0.098 kPa),(27.41±5.62)cmH_(2)O,(50.01±6.32)mmHg(1 mmHg=0.133 kPa),(14.21±2.32)ng/L,(0.18±0.03)ng/L,and(28.62±6.85)ng/L,which were significantly lower than those of the control group[(18.05±2.36)cmH_(2)O/L•s,(25.05±4.11)cmH_(2)O,(53.85±8.47)mmHg,(26.65±3.96)ng/L,(0.29±0.08)ng/L,and(35.74±9.52)ng/L](all P<0.05).The P_(peak),SpO_(2),PaO_(2),FEV_(1),FEV_(1)/FVC,and PEF of the observation group were(14.65±1.44)cmH_(2)O,(96.45±17.05)%,(70.52±8.96)mmHg,(61.25±8.45)%,(68.74±9.45)%,and(4.89±0.56)L/s,which were significantly higher than those of the control group[(16.05±1.96)cmH_(2)O,(94.11±15.14)%,(68.01±6.85)%,(48.33±6.45)%,(59.78±6.08)%,and(4.24±0.39)L/s](all P<0.05).The 28 d mortality rate of the observation group was 9.52%(4/42),which was lower than that of the control group[28.57%(12/42)];the ventilation time of the observation group was(9.52±2.32)d,which was shorter than that of the control group[(11.36±3.69)d];the withdrawal success rate of the observation group was 95.24%(40/42),which was higher than that of the control group[73.81%(31/42)](all P<0.05).Conclusion ECMO has an ideal effect in the treatment of respiratory failure,which is beneficial to improve the blood gas analysis indexes and reduce the mortality rate.