暴发性心肌炎ECMO治疗期间发生不良预后的影响因素分析及应对策略研究

Influencing factors and coping strategies of bad prognosis of explosive myocarditis during ECMO treatment

目的分析暴发性心肌炎接受体外膜肺氧合(ECMO)治疗期间发生不良预后的危险因素,并探讨具体应对策略。方法本文为回顾性研究,病例纳入黄河三门峡医院2021年1月至2023年1月收治的70例暴发性心肌炎患者,所有患者均接受ECMO治疗,根据治疗情况,将28例治疗期间发生不良预后的患者列为高风险组,将未发生不良预后的42例患者列为对照组,收集、对比两组患者的一般资料、临床资料,经统计学单因素分析、Logistic多因素回归分析归纳可导致患者ECMO治疗期间发生不良预后的危险因素,结合分析结果,探讨具体应对策略。结果统计学单因素分析结果显示,两组患者的性别、年龄、合并症、入院时基础体征、血液指标、心功能、心肌功能、治疗情况均差异有统计学意义(P<0.05);Logistic多因素回归分析结果显示,合并脑出血、合并胃肠道疾病、合并多器官衰竭、入院时呼吸频率(RR)≥20次/min,收缩压(SBP)≤90mmHg,舒张压(DBP)≤60mmHg、白细胞计数(WBC)≥10×109L、中性粒细胞百分比(NE)≥70%、左室射血分数(LVEF)≤40%、QRS间期>120 ms、PR间期>178 ms、血清乳酸(LDH)水平≥37 U/L、肌酸激酶同工酶(CK-MB)≥23 U/L、心肌肌钙蛋白Ⅰ(cTnⅠ)≥18 ng/mL、实施主动脉球囊反搏(IABP)治疗、实施呼吸机辅助、应用β受体阻滞剂、应用正性肌力药为导致ECMO治疗期间发生不良预后的危险因素。结论合并多种基础疾病、入院时体征异常、合并感染症状、存在心功能、心肌功能损伤、实施IABP治疗、呼吸机辅助并应用β受体阻滞剂或正性肌力药为导致暴发性心肌炎接受ECMO治疗期间发生不良预后的危险因素,全面评估患者身体状况,纠正基础体征,积极治疗原发病,改善心功能、心肌功能并慎用IABP、呼吸机或相关药物是提升ECMO治疗安全性的重要举措。

【Objective】To analyze the risk factors of adverse prognosis during the treatment of explosive myocarditis with ECMO,and explore specific coping strategies.【Methods】This is a retrospective study.The case was included from January 2021 to January 2023.The study object was 70 patients with explosive myocarditis.All patients received ECMO treatment.According to the treatment,28 patients with adverse prognosis during treatment were classified as high-risk group,and 42 patients without adverse prognosis were classified as control group.General data and clinical data of the two groups were collected and compared.Logistic multivariate regression analysis summarized the risk factors that can lead to poor prognosis during ECMO treatment in patients,and combined the analysis results to explore specific coping strategies.【Results】The results of statistical univariate analysis showed that there were certain differences in gender,age,comorbidities,basic physical signs at admission,blood indicators,heart function,myocardial function,and treatment status between the two groups of patients(P<0.05).The results of logistic multiple factor regression analysis showed that patients with cerebral hemorrhage,gastrointestinal diseases,multiple organ failure,RR≥20 times/min,SBP≤90 mmHg,DBP≤60 mmHg,and WBC 9≥10×10 L at admission,NE≥70%,LVEF≤40%,QRS interval>120 ms,PR interval>178 ms,LDH level≥37 U/L,CK-MB≥23 U/L,cTn I≥18 ng/mL,implementation of IABP treatment,implementation of ventilator assistance,application ofβreceptor blockers and the use of positive inotropic drugs are risk factors for poor prognosis during ECMO treatment.【Conclusion】Merge multiple underlying diseases,abnormal physical signs upon admission,concurrent infection symptoms,presence of cardiac function,myocardial dysfunction,implementation of IABP therapy,and application of ventilator assistance,βreceptor blockers or positive inotropic agents are risk factors for adverse prognosis during ECMO treatment of explosive myocarditis.Comprehensive assessment of patients'physical conditions,correction of basic signs,active treatment of primary diseases,improvement of cardiac function and myocardial function,and careful use of IABP,respirator or related drugs are important measures to improve the safety of ECMO treatment.