早期肠内营养对成人心脏术后静脉-动脉体外膜肺氧合患者近期预后的影响

Effects of early enteral nutrition on short-term prognosis of adult patients receiving veno-arterial extracorporeal membrane oxygenation after cardiac surgery

目的探讨早期肠内营养(early enteral nutrition,EEN)对成人心脏术后静脉-动脉体外膜肺氧合(veno-arterial extracorporeal membrane oxygenation,V-A ECMO)患者近期预后的影响。方法回顾性收集2017年12月至2022年4月阜外华中心血管病医院成人心血管外科重症监护病房收治心脏术后循环衰竭V-A ECMO支持患者的临床资料。根据ECMO植入后启用肠内营养是否>48 h分为两组,即EEN组(≤48 h)及延迟肠内营养(delayed enteral nutrition,DEN)组(>48 h)。对比两组患者的胃肠道并发症、院内感染率、ECMO辅助时间、ICU时间、住院时间及住院病死率,采用Kaplan-Meier分析法绘制住院生存曲线,Log-Rank检验两组住院生存率的差异;使用Cox比例风险模型探究影响患者住院死亡的因素。结果共纳入56例患者,EEN组27例,DEN组29例。EEN组消化道出血发生率低于DEN组(14.8%vs.41.4%,P=0.015),住院病死率低于DEN组(29.6%vs.58.6%,P=0.026)。Log-Rank检验显示,EEN组住院生存率明显高于DEN组(χ^(2)=5.312,P=0.021)。Cox回归分析显示,EEN及术后主动脉内球囊反搏(IABP)的应用是心脏术后V-A ECMO支持患者住院死亡的影响因素(HR=0.323,95%CI 0.129~0.805,P=0.015;HR=0.373,95%CI 0.160~0.869,P=0.022)。结论EEN及术后IABP的使用可降低成人心脏术后V-A ECMO支持患者住院死亡风险。

Objective To investigate the effects of early enteral nutrition(EEN)on short-term prognosis of adult patients receiving veno-arterial extracorporeal membrane oxygenation(V-A ECMO)after cardiac surgery.Methods We retrospectively collected the clinical data of the adult patients who received V-A ECMO after cardiac surgery for severe hemodynamic failure in Fuwai Central China Vascular Hospital from December 2017 to April 2022.They were divided into two groups based on the time of enteral nutrition after the initiation of ECMO:the early enteral nutrition(EEN)group(within 48 h)and the delayed enteral nutrition(DEN)group(over 48 h).The gastrointestinal(GI)complications,nosocomical infections,duration of ECMO,lengths of ICU stay and hospital stay,in-hospital mortality between the two groups were analyzed.The hospitalization survival curve was drawn by Kaplan-Meier analysis method.The differences of in-hospital survival were compared by Log-Rank test between the two groups.Cox proportional risk model was used to identify the independent risk factors of in-hospital mortality.Results 56 cases were enrolled(27 cases in EEN,29 cases in DEN),the incidences of gastrointestinal beeding and in-hospital mortalities in EEN group were significantly lower than those in DEN group(14.8%vs.41.4%,P=0.015;29.6%vs.58.6%,P=0.026).Log-Rank results showed that the in-hospital survial of EEN group was higher than that of DEN group(χ^(2)=5.312,P=0.021).The Cox regression analysis displayed that EEN and the use of postoperative intra-aortic balloon pump(IABP)were influencing factors for in-hospital mortality of the patients receiving V-A ECMO after cardiac surgery(HR=0.323,95%CI 0.129-0.805,P=0.015;HR=0.373,95%CI 0.160-0.869,P=0.022).Conclusions EEN and the use of postoperative IABP can reduce the incidence of in-hospital mortality for adult patients receiving V-A ECMO after cardiac surgery.