心脏术后体外膜氧合患者撤机失败的危险因素分析

Risk factors for unsuccessful weaning from extracorporeal membrane oxygenation in patients undergoing cardiac surgery

目的:分析体外膜氧合(extracorporeal membrane oxygenation,ECMO)辅助患者血浆中可溶性生长刺激表达基因2蛋白(soluble growth stimulation expressed gene 2,sST2)水平的增加与心外术后接受ECMO辅助的患者的撤机失败是否存在相关性。方法:回顾性分析2017年1月至2019年7月,在北京安贞医院心脏外科危重症中心,心脏术后接受ECMO辅助的患者数据,按照患者是否成功撤机分为成功撤机组和撤机失败组,分析sST2在两组差异。用逻辑回归分析验证s ST2是否是撤机失败的独立危险因素。结果:最终纳入116例患者,其中,成功撤机组87例,撤机失败组29例。与成功撤机组相比,ECMO辅助后24h后的乳酸(2.5 vs. 4.9 mmol/L,P<0.001)、BNP(401.5 vs. 1326.5 ng/L,P <0.001)、凝血酶原时间(15.1 vs.17.5s,P=0.024),在撤机失败组中更高。成功撤机组中合并高血压患者的比例高于撤机失败组的患者(54.0%vs. 27.6%,P=0.014)。多因素Logistics回归分析结果,sST2和BNP水平升高是ECMO患者撤机失败的危险因素(P<0.05)。结论:s ST2水平升高是ECMO患者撤机失败的危险因素。

Objective:To analyze whether the increase of plasma soluble growth stimulation expressed gene 2(sST2)level is correlated with unsuccessful weaning from extracorporeal membrane oxygenation(ECMO)in patients undergoing cardiac surgery.Methods:Data of patients who received ECMO support for postcardiotomy cardiogenic shock between January 2017 and July 2019 were retrospectively collected from Beijing Anzhen Hospital.Results:Ultimately,116 patients were included in the present study for analysis.Among them,87 people were successfully weaning from ECMO,and 29 people were unsuccessful weaning.Compared with successful weaning group,the lactate level(2.5 vs.4.9 mmol/L,P=0.001),BNP level(401.5 vs.1326.5 ng/L,P=0.001),and prothrombin time(PT)(15.1 vs.17.5s,P=0.024)after 24 hours of ECMO support were higher in the unsuccessful weaning group.The proportion of patients with hypertension in the successful weaning group was higher than that in the unsuccessful weaning group(54.0%vs.27.6%,P=0.014).Multivariate logistic regression analysis showed that increased sST2 and BNP levels were independent risk factors for unsuccessful weaning from extracorporeal membrane oxygenation in patients undergoing cardiac surgery(P<0.05).Conclusions:Increased sST2 level is an independent risk factor for unsuccessful weaning from extracorporeal membrane oxygenation in patients undergoing cardiac surgery.