ECMO对心源性休克患者血流动力学、血氧水平的影响

Effect of ECMO on hemodynamics and blood oxygen level in patients with cardiogenic shock

目的探讨体外膜肺氧合(ECMO)对心源性休克(CS)患者血流动力学及血氧水平的影响。方法选取95例CS患者作为研究对象,按随机数字表法将其分为对照组(n=47)与观察组(n=48)。对照组进行主动脉内球囊反搏治疗,观察组进行ECMO治疗。比较两组患者治疗前后的血流动力学指标和血氧水平、心功能指标水平,以及治疗后1个月的不良反应发生情况。结果治疗前两组患者的各项血流动力学指标和血氧水平、心功能指标水平比较,差异均无统计学意义(均P>0.05)。治疗后,两组患者的心率、中心静脉压、乳酸值、左室舒张期末内径均低于治疗前且观察组均低于对照组,两组患者的平均动脉压、pH值、中心静脉血氧饱和度、左室射血分数均高于治疗前,且观察组均高于对照组(均P<0.05)。两组患者的肾衰竭、肺感染、出血、新发心房颤动等不良反应发生率比较,差异均无统计学意义(均P>0.05)。结论ECMO对CS患者血流动力学及血氧水平具有正性影响,可改善患者心功能,有利于血流动力学稳定,维持正常血氧,在较短时间内缓解休克症状,且具有较高安全性。

Objective To investigate the effect of extracorporeal membrane oxygen(ECMO)on hemodynamics and blood oxygenation level in patients with cardiogenic shock(CS).Methods A total of 95 patients were selected as research objects and randomly divided into control group(n=47)and observation group(n=48)according to the random number table method.The control group was treated with intra-aortic balloon counterpulsation,and the observation group was treated with ECMO.The hemodynamic indexes,blood oxygen levels,cardiac function indexes before and after treatment,and the occurrence of adverse reactions 1 month after treatment were compared between the two groups.Results Before treatment,there was no statistically significant difference in various hemodynamic indexes and the levels of blood oxygen and cadiac function indexes between the two groups(all P>0.05).After treatment,the heart rate,central venous pressure,lactic acid value and left ventricular end diastolic diameter of the two groups were lower than those before treatment,and those in the observation group were lower than those in the control group;the mean arterial pressure,pH value,central venous oxygen saturation and left ventricular ejection fraction in both groups were higher than those before treatment,and those in the observation group were higher than those in the control group(all P<0.05).There was no statistically significant difference in the incidence of adverse reactions such as renal failure,pulmonary infection,hemorrhage and emerging arterial fibrillation between the two groups(all P>0.05).Conclusion ECMO has a positive effect on hemodynamics and blood oxygen level in patients with CS,which can improve cardiac function,be conducive to hemodynamic stability,maintain normal blood oxygen,relieve shock symptoms in a short time,and has high safety.