VA-ECMO联合IABP对心源性休克患者超声心动图参数及预后的影响

Effects of venous arterial extracorporeal membrane oxygenation combined with IABP on echocardiographic parameters and prognosis in patients with cardiogenic shock

目的分析静脉-动脉体外膜肺氧合(VA-ECMO)联合主动脉内球囊反搏(IABP)对心源性休克(CS)患者超声心动图参数及预后的影响。方法选取2017年6月—2022年6月成都市第三人民医院收治的CS患者105例,依据治疗方式对两组进行分组,接受IABP治疗的为对照组,共54例,接受VA-ECMO联合IABP治疗的为实验组,共51例。对比两组治疗前后超声心动图参数[左室射血分数(LVEF)、呼吸变异指数(△RVI)、主动脉速度/时间的积分变异指数(△VTI)、中心静脉压(CVP)、心率(HR)、心指数(CI)];比较两组治疗前后心功能相关指标[平均动脉压(MAP)、肌酸激酶同工酶(CK-MB)、肌钙蛋白T(cTnT)、肌酸激酶(CK)、B型钠尿肽(BNP)];对比两组治疗前后血气分析指标[pH、HCO_(3)^(-)、静脉的血氧饱和度(SvO_(2))、乳酸、二氧化碳分压(PaCO_(2))、氧合指数];比较两组血管活性药物[去甲肾上腺素(NE)、肾上腺素(E)、多巴胺(DA)]使用情况;对比两组并发症及预后情况。结果治疗后,实验组△VTI、SvO_(2)及CI较对照组高(P<0.05),两组HR、LVEF、CVP、△RVI无统计学差异(P>0.05)。治疗后,实验组MAP较对照组更高(P<0.05),cTnI、BNP、CK、CK-MB较对照组低(P<0.05)。治疗后,实验组HCO_(3)^(-)较对照组高(P<0.05),乳酸较对照组低(P<0.05),两组pH、PaCO_(2)、氧合指数无统计学差异(P>0.05)。实验组治疗后NE、E用药量均较对照组更少(P<0.05)。治疗期间,两组并发症总发生率无统计学差异(P>0.05)。实验组撤机成功率较对照组更高(P<0.05),住院期间死亡率较于对照组低(P<0.05),两组30 d内死亡率无统计学差异(P>0.05)。结论VA-ECMO联合IABP用于CS治疗能改善患者超声心动图参数,促进心功能恢复,降低心血管药物使用量,提高撤机率,并减少死亡的发生。

Objective To study the effects of venous arterial extracorporeal membrane oxygenation(VA-ECMO)combined with intra-aortic balloon pump(IABP)on echocardiogram parameters and prognosis in patients with cardiogenic shock(CS).Methods A total of 105 patients with CS who were admitted to CCU of the Third People's Hospital of Chengdu between June 2017 and June 2022were conducted on this study.All patients were divided into two groups:control group 54 cases(IABP only)and experimental group 51 cases(VA-ECMO combined IABP).Complications and prognosis of the two groups were compared.All tests were analyzed including the echocardiogram parameters[left ventricular ejection fraction(LVEF),respiratory variation index(△RVI),velocity-time integral variation index(△VTI),central venous pressure(CVP),heart rate(HR),oxygen saturation venous blood(SvO_(2)),cardiac index(CI)];cardiac function indexes[mean arterial pressure(MAP),creatine kinase MB(CK-MB),cardiac troponin I(cTnI),creatine kinase(CK),B-type natriuretic peptide(BNP)];and blood gas analysis indexes(pH,HCO_(3)^(-),lactic acid,PaCO_(2),oxygenation index)before and after treatment;use of vasoactive agentsnorepinephrine(NE)and epinephrine(E).Results The△VTI,SvO_(2)and CI inexperimental group were higher than those in control group(P<0.05).There was no significant difference inHR,CVP,LVEF or△RVI between the two groups(P>0.05).MAP in experimental group was higher than that in control group(P<0.05),while CK,CK-MB,cTnI and BNP were lower than those in control group(P<0.05).HCO_(3)^(-)in experimental group was higher than that in control group(P<0.05),lactic acid was lower than that in control group(P<0.05),but there was no significant difference inpH,PaCO_(2)or oxygenation index between the two groups(P>0.05).Dosages of NE and E in experimental group were lower than those in control group(P<0.05).There was no significant difference in the incidence of complications between the two groups during treatment(P>0.05).The success rate of weaning in experimental group was higher than that in control group(P<0.05).Mortality during hospitalizationtreatments in experimental group was lower than that in control group(P<0.05),but there was no difference in mortality within 30 d between the two groups(P>0.05).Conclusion VA-ECMO combined with IABP can improve echocardiogram parameters,promote the recovery of cardiac function,reduce dosages of cardiovascular drugs,increase weaning rate and reduce the occurrence of death in patients with CS in our study.