体外膜肺氧合技术救治心搏骤停患者的临床结局与预后影响因素分析

Analysis of clinical outcomes and prognostic factors of extracorporeal membrane oxygenation in patients with cardiac arrest

目的:分析应用体外膜肺氧合(ECMO)技术救治心搏骤停患者过的结局与影响预后的因素。方法:回顾性分析2021年1月—2022年10月郑州人民医院急诊科收治的42例采用体外膜肺氧合技术救治的体外心肺复苏(ECPR)患者,根据救治患者的临床结局分为存活组(n=12)和死亡组(n=30)。比较两组的基本资料以及ECPR启动前后的检验结果。结果:42例ECPR患者的总体生存率为28.57%。存活组的发病距上机时间短于死亡组,上机24 h后,存活组的乳酸、降钙素原(PCT)水平低于死亡组,pH值高于死亡组,差异均有统计学意义(P<0.05)。上机前pH值是死亡独立危险因素,ROC曲线预测死亡风险的曲线下面积(AUC)为0.779。上机前pH、乳酸和PCT预测死亡风险的AUC为0.778。结论:V-A ECMO建立前24 h的pH值为ECMO辅助支持治疗心搏骤停患者院内死亡的独立危险因素,上机前的pH、乳酸、PCT三者联合检测对评估ECPR预后具有指导意义。

Objective To provide effective prognostic factors for the application of extracorporeal membrane oxygenation(ECMO)technology in the treatment of patients with cardiac arrest.Methods A total of 42 extracorporeal cardiopulmonary resuscitation(ECPR)patients admitted to the Department of Emergency of Zhengzhou People’s Hospital from January 2021 to October 2022 were retrospectively included.According to the clinical outcomes of patients,they were divided into the survival group(n=12)and the death group(n=30).The basic data of the two groups and the test results before and after ECPR initiation were compared.Results The overall survival rate of 42 ECPR patients was 28.57%.The pH value before use was an independent risk factor for death,and the area under the curve(AUC)of ROC curve predicting the risk of death was 0.779.The predicted AUC of death risk for pH,lactate,and procalcitonin(PCT)before use was 0.778.Conclusion The pH value at 24 hours before the establishment of V-A ECMO is an independent risk factor for in-hospital death in patients with cardiac arrest treated with ECMO assisted support.The combined detection of pH,lactate,and PCT before use has guiding significance in evaluating the prognosis of ECPR.