体外膜肺氧合在主动脉手术后应用的院内死亡危险因素分析

摘要

Objective To evaluate risk factors of in-hospital mortality during extracorporeal membrane oxygenation(ECMO) support for those with refractory cardiogenic shock after aortic surgery.Methods Retrospective analyses were conducted for 35 patients using ECMO after aortic surgery at Beijing Anzhen Hospital,Capital Medical University from September 2009 to March 2016.Demographic characteristics,diagnosis,ECMO related data,including ECMO indication,operation,clinical parameters before and 24 hours during ECMO were collected to set up a database.The patients were divided into survival group and non-survival group according to the prognosis.The risk factors of mortality in hospital after ECMO were analyzed by multivariate logistic regression analysis regression.Results There were 35 adult patients who had received ECMO support with 32 male and 3female.All patients received veno-arterial ECMO (V-A ECMO).ECMO was successfully weaned in 22 patients (62.9％),and 18 patients(51.4％) survived.Multivariate logistic regression analysis revealed that high lactic acid levels at 12 hours after ECMO(OR =1.445;95％ CI:1.026-2.034) and multiple organ dysfunction syndrome(MODS,OR =10.412;95％ CI:2.246-70.798)(P ＜ 0.05) were independent risk factors of in-hospital mortality in adult patients undergoing ECMO after aortic surgery.Conclusion High lactic acid levels at 12 hours after ECMO and MODS were very important factors of patients undergoing ECMO after aortic surgery.The proper identification and management shall improve the prognosis of patients.%目的 探讨主动脉手术后应用体外膜肺氧合(Extracorporeal Membrane Oxygenation,ECMO)患者发生院内死亡的危险因素及意义.方法 回顾性分析2009年9月至2016年3月在我院应用ECMO的35例主动脉手术患者的临床资料,记录患者的人口学特征、疾病诊断,ECMO建立时的临床资料,如应用指征、手术情况、ECMO建立前及建立24 h内患者各项临床指标,按患者是否存活出院分为存活组和院内死亡组;通过多因素logistic回归分析确定院内死亡的独立危险因素.结果 35例主动脉手术后应用ECMO的患者中,男32例,女3例,ECMO支持模式均为静脉-动脉ECMO模式(V-A ECMO);其中22例(62.9％)成功脱离ECMO,18例(51.4％)成功出院.多因素logistic回归模型显示患者院内死亡的独立危险因素是ECMO辅助12h高乳酸值(OR=1.445;95％ CI:1.026～2.034)、多脏器功能障碍综合征(multiple organ dysfunction syndrome,MODS,OR=10.412;95％ CI:2.246～ 70.798)(P＜0.05).结论 ECMO辅助12 h高乳酸值、MODS是决定主动脉手术后应用ECMO患者院内死亡的主要危险因素,识别危险因素对提高此类患者救治成功率有益.