ECPR患者ECMO支持早期发作室颤/室速与预后关系

Relationship between early onset ventricular fibrillation/ventricular tachycardia and prognosis in ECPR patients with ECMO support

目的:回顾分析体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)患者在体外膜肺氧合(extracorpo⁃real membrane oxygenation,ECMO)早期(72 h内)的室颤/室速(ventricular fibrillation/ventricular tachycardia,VF/VT)发生率、危险因素及对预后的影响。方法:纳入2017年1月—2023年3月南京医科大学第一附属医院急诊中心的ECPR患者,根据ECMO运行72 h内是否发作VF/VT分为VF/VT组和nVF/VT组,回归分析ECMO支持下VF/VT发作的危险因素,并探究VF/VT对临床预后的影响。结果:95例患者,年龄(50.02±15.93)岁,其中男66.32%,28 d存活率51.58%,VF/VT的发生率为33.33%。组间比较显示,nVF/VT组持续性肾替代治疗使用率、ECMO启动时间、乳酸均高于VF/VT组,VF/VT肌钙蛋白T(troponin T,TnT)呈高水平趋势;VF/VT组的pH值显著低于nVF/VT组。逐步法多因素Logistic回归显示,发生VF/VT后,TNT维持高水平的风险显著增大(OR=18.156,95%CI:3.620~91.059);ECMO启动时间延长(OR=1.118,95%CI:1.060~1.180)和pH值下降(OR=0.005,95%CI:0.000~0.953)是VF/VT发生的独立危险因素。结论:在ECPR患者中,严重酸中毒或ECMO启动时间延长的患者在ECMO支持72 h内发生VF/VT的风险明显增加,VF/VT发作并不影响主要临床预后,但可能会加重心肌损伤。

Objective:To retrospectively analyzethe incidence,risk factors,and prognosis of ventricular fibrillation/ventricular tachycardia(VF/VT)within 72 hours of extracorporeal cardiopulmonary resuscitation(ECPR)in patients supported by extracorporeal membrane oxygenation(ECMO).Methods:ECPR patients admitted to the Emergency Center of the First Affiliated Hospital of Nanjing Medical University from January 2017 to March 2023 were included.Patientswere divided into VF/VT group and nVF/VT group according to the occurrence of VF/VT within 72 hours of ECMO support.risk factors for VF/VT during ECMO support were analyzed through regression analysis,and the impact of VF/VT on clinical prognosis was explored.Results:A total of 95 patients with a mean age of(50.02±15.93)years were enrolled,with males accounting for 66.32%.The 28⁃day survival rate was 51.58%,and the incidence of VF/VT was 33.33%.Comparison among groups showed that the nVF/VT group had a higher rates of continuous renal replacement therapy,longer ECMO initiation time,and higher lactic acidlevels compared tothe VF/VT group.Troponin T(TnT)levels showed a trend of being higher in the VF/VT group,while the pH value was significantly lower in the VF/VT group compared to the nVF/VT group.Stepwise multivariable logistic regression analysis showed that the risk of maintaining high TNT levels significantly increased after VF/VToccurrence,with an odds ratio(OR)of 18.156(95%CI:3.620-91.059).Prolonged ECMO initiation time(OR=1.118,95%CI:1.060-1.180)and decreased pH value(OR=0.005,95%CI:0.000-0.953)were identified as independent risk factors for VF/VT occurrence.Conclusion:In patients with ECPR,the risk of VF/VT occurring within 72 hours of ECMO support issignificantly increased in patients with severe acidosis or prolonged ECMO initiation time.The onset of VF/VT does not affect the clinical prognosis but may exacerbate myocardial injury.