高体质量指数的特发性肺纤维化患者接受体外膜肺氧合支持的相关结局

Outcomes of idiopathic pulmonary fibrosis patients with high body mass index undergoing extracorporeal membrane oxygenation support

目的评估肺移植术中接受体外膜肺氧合(ECMO)支持的高体质量指数(BMI,>25 kg/m^(2))的特发性肺纤维化(IPF)患者在重症监护病房(ICU)住院期间的ECMO相关结局。方法采用回顾性观察性研究,纳入2019至2020年在南京医科大学附属无锡人民医院肺移植术中接受ECMO支持的IPF患者。收集患者术前指标,如人口学指标、合并症、动脉血气、实验室指标;术中指标,如肺叶减容、手术类型、手术时间、冷缺血时间、失血量和输血量;入ICU即刻指标,如血气分析和实验室指标;ECMO相关结局,如ECMO模式、ECMO支持时间、ECMO相关并发症(置管处出血、导管内血栓、下肢缺血);以及ICU住院时间、机械通气时间和30 d生存率。根据BMI将患者分为3组,体质量偏轻组(BMI<18.5 kg/m^(2))、体质量正常组(BMI 18.5~24.9 kg/m^(2))、体质量超重组(BMI≥25.0 kg/m^(2))。主要对患者在ICU期间的ECMO相关结局进行比较。结果共纳入114例肺移植术中接受ECMO支持的IPF患者,其中体质量偏轻组23例,体质量正常组63例,体质量超重组28例。与体质量偏轻和体质量正常的患者相比,体质量超重的患者术前多患有高血压(46.4%比8.7%、23.8%,P<0.01)和冠心病(32.1%比4.3%、20.6%,P<0.05),符合国际指南对于肥胖的共识;其余临床资料(术前、术中、ICU特征)差异均无统计学意义,具有可比性。在ECMO相关结局方面,体质量偏轻组、体质量正常组、体质量超重组ECMO模式〔静脉-静脉(V-V)模式:78.3%、77.8%、78.6%,静脉-动脉(V-A)模式:21.7%、22.2%、21.4%〕、ECMO支持时间(h:61.70±20.03、44.57±5.76、41.77±7.26)、ECMO相关并发症(置管处出血:4.3%、7.9%、14.3%,导管内血栓:8.7%、12.7%、17.9%,下肢缺血:8.7%、12.7%、14.3%)、ICU住院时间(d:11±3、7±1、9±1)、机械通气时间〔d:2(2,11)、2(2,6)、3(2,8)〕差异均无统计学意义(均P>0.05)。Kaplan-Meier生存曲线分析显示,3组30 d累积生存率差异也无统计学意义(Log-Rank检验:χ^(2)=0.919,P=0.632)。结论接受肺移植的IPF患者并不会因为BMI过高而出现ECMO相关结局的恶化和不良的早期预后,BMI作为单一参数也不应成为IPF患者在肺移植手术中应用ECMO的禁忌证。

Objective To evaluate the extracorporeal membrane oxygenation(ECMO)related outcomes during hospitalization during the intensive care unit(ICU)in idiopathic pulmonary fibrosis(IPF)patients with high body mass index(BMI,>25 kg/m^(2))undergoing lung transplantation with ECMO support.Methods A retrospective observational study was conducted.IPF patients who received ECMO during lung transplantation admitted to the Affiliated Wuxi People's Hospital of Nanjing Medical University from 2019 to 2020 were enrolled.Preoperative indicators including,demographics,comorbidities,arterial blood gas,and laboratory indicators;intraoperative indicators,such as lung lobe volume reduction,surgical type,surgical time,cold ischemia time,blood loss and transfusion volume;immediate indicators upon admission to the ICU,such as blood gas analysis and laboratory indicators;ECMO related outcomes,such as ECMO mode,ECMO support time,ECMO related complications(bleeding at the catheterization site,intraductal thrombosis,lower limb ischemia),and the length of ICU stay,duration of mechanical ventilation,and 30-day survival rate were collected.According to BMI,patients were divided into three groups:light weight group(BMI<18.5 kg/m^(2)),normal weight group(BMI 18.5-24.9 kg/m^(2)),and overweight group(BMI≥25.0 kg/m^(2)).Mainly to compare the relevant outcomes of ECMO among patients during ICU.Results A total of 114 IPF patients who received ECMO support during lung transplantation were collected,including 23 cases in the light weight group,63 cases in the normal weight group,and 28 cases in the overweight group.Compared with patients with underweight and normal weight,overweight patients were more likely to have hypertension(46.4%vs.8.7%,23.8%,P<0.01)and coronary heart disease(32.1%vs.4.3%,20.6%,P<0.05)before surgery,which was consistent with international guidelines for obesity.Other clinical data(preoperative,intraoperative,ICU characteristics)showed no statistically significant differences and were comparable.There was no statistically significant difference in terms of ECMO related outcomes,such as ECMO related complications[veno-venous(V-V)mode:78.3%,77.8%,78.6%,veno-arterial(V-A)mode:21.7%,22.2%,21.4%],ECMO support time(hours:61.70±20.03,44.57±5.76,41.77±7.26),ECMO related complications(bleeding at the catheterization site:4.3%,7.9%,14.3%;intraductal thrombosis:8.7%,12.7%,17.9%;lower limb ischemia:8.7%,12.7%,14.3%),and the length of ICU stay(days:11±3,7±1,9±1),duration of mechanical ventilation[days:2(2,11),2(2,6),3(2,8)]among the light weight group,normal weight group,and overweight group(all P>0.05).Kaplan-Meier survival curve analysis showed that there was no statistically significant difference in the 30-day cumulative survival rate among the three groups(Log-Rank test:χ^(2)=0.919,P=0.632).Conclusions High BMI does not worsen ECMO-related outcomes or adversely affect early prognosis in IPF patients undergoing lung transplantation.BMI as a single parameter should not be a contraindication for the use of ECMO in lung transplantation surgery for IPF patients.