体外膜肺氧合患者早期急性胃肠损伤及影响因素分析

Analysis of early acute gastrointestinal injury and its influencing factors in patients with extracorporeal membrane oxygenation

目的探讨体外膜肺氧合(ECMO)患者上机早期的急性胃肠损伤(AGI)及影响因素。方法回顾分析2020年9月至2021年12月于广西壮族自治区人民医院急诊监护病房住院治疗的ECMO患者共70例,按照2012年欧洲重症医学会关于重症患者急性胃肠损伤分级指导意见,将患者分为AGI组与非AGI组,统计其早期急性胃肠损伤的发生率,并对其ECMO上机时血气分析结果及ECMO转机后ECMO参数、血流动力学指标及生化指标进行统计分析,探讨其早期发生AGI的影响因素及独立危险因素。另外将70例患者按照是否撤机成功分为撤机成功组与未撤机成功组,比较两组间急性胃肠损伤的发生情况,分析急性胃肠损伤的发生对ECMO患者撤机的影响。结果70例ECMO患者中,早期AGI的发生率为71.43%(50例),其中AGIⅠ、Ⅱ、Ⅲ、Ⅳ级的构成依次为18.57%(13例)、41.43%(29例)、11.43%(8例)、0%(0例);①单因素分析显示:AGI组与非AGI组相比较,ECMO上机时收缩压、舒张压、平均动脉压(MAP)、血管活性药物指数(VIS)、pH、乳酸、BMI差异有统计学意义(P<0.05);②Logistic二元回归分析显示:BMI是ECMO患者早期发生AGI的独立危险因素(ROC曲线下面积为0.657,95%可信区间为0.522~0.791(P<0.05),约登指数为0.15);③撤机成功组与未成功撤机组比较,未成功撤机组AGI的构成比更高,差异有统计学意义(P<0.05)。结论ECMO患者早期有较高的AGI发生率,主要发生Ⅰ、Ⅱ级,ECMO上机时收缩压、舒张压、MAP、VIS、pH、乳酸、BMI是ECMO患者早期发生AGI的影响因素,其中,BMI是ECMO患者早期发生AGI的独立危险因素。AGI的发生降低了ECMO患者的成功撤机率。

Objective To investigate the acute gastrointestinal injury(AGI)in patients with extracorporeal membrane oxygenation(ECMO)at the early stage of operation and its influencing factors.Methods A total of 70 patients with ECMO who were hospitalized in the Emergency Care Unit of Guangxi Zhuang Autonomous Region People's Hospital from September 2020 to December 2021 were retrospectively analyzed,and a total of 70 patients with ECMO who were hospitalized in the emergency care unit of Guangxi Zhuang Autonomous Region People's Hospital from September 2020 to December 2021 were retrospectively analyzed.According to the 2012 guidelines of the European Society of Intensive Care Medicine on the classification of acute gastrointestinal injury in critically ill patients,the patients were divided into AGI group and non-AGI group.The incidence of acute gastrointestinal injury in the early stage was statistically analyzed,and the results of blood gas analysis during ECMO loading and ECMO parameters,hemodynamic indexes and biochemical indexes after ECMO transfer were statistically analyzed.To explore the influencing factors and independent risk factors of AGI in the early stage.In addition,70 patients were divided into successful group and non-successful group according to whether they were successfully withdrawn.The occurrence of acute gastrointestinal injury between the two groups was compared,and the effect of acute gastrointestinal injury on ECMO patients was analyzed.Results Among the 70 ECMO patients,the incidence of early AGI was 71.43%(50 cases),and the components of AGIⅠ,Ⅱ,ⅢandⅣwere 18.57%(13 cases),41.43%(29 cases),11.43%(8 cases)and 0%(0 cases),respectively.①Univariate analysis showed that systolic blood pressure,diastolic blood pressure,mean arterial pressure(MAP),vasoactive drug index(VIS),pH,lactic acid and BMI were significantly different between AGI group and non-AGI group when ECMO was used(P<0.05).Logistic binary regression analysis showed that BMI was an independent risk factor for early AGI in ECMO patients(ROC area 0.657,95%confidence interval 0.522-0.791(P<0.05),and Yoden index 0.15).(3)The AGI composition ratio of the unsuccessful group was higher than that of the unsuccessful group(P<0.05).Conclusions Patients with ECMO have a high incidence of AGI in the early stage,mainly occurring in grade I andⅡ.Systolic blood pressure,diastolic blood pressure,MAP,VIS,pH,lactic acid and BMI when ECMO is put on are influential factors for the early development of AGI in ECMO patients,among which BMI is an independent risk factor for the early development of AGI in ECMO patients.The occurrence of AGI reduces the probability of successful withdrawal in ECMO patients.