摘要
目的探讨心脏外科术后清醒体外膜氧合(ECMO)实施时机、预后获益及影响因素。方法回顾性分析空军军医大学第一附属医院2022年1月至2024年6月56例心脏术后清醒ECMO患者临床资料。依据ECMO期间是否机械通气分为完全清醒组和非完全清醒组;非完全清醒组ECMO期间机械通气时间以占ECMO总辅助时间40%为界限,<40%为早期清醒亚组,≥40%为非早期清醒亚组;分别比较两组患者的基线资料、拔管因素及预后,分析非完全清醒组早期拔出气管插管的影响因素。结果完全清醒组出院存活率高于非完全清醒组(P=0.04);完全清醒组较非完全清醒组总机械通气时间、ICU停留时间、住院时间更短,重要并发症发生率更低。早期清醒亚组出院存活率高于非早期清醒亚组(P<0.001),主要并发症发生率低于非早期清醒亚组。清醒ECMO期间患者白蛋白和前白蛋白较气管插管期间明显改善(P<0.05)。多因素分析影响心外术后清醒静脉-动脉ECMO实施主要因素包括术后肺部并发症和氧合指数。结论在心脏外科术后静脉-动脉ECMO支持患者中适当的早期清醒能够改善预后,减少主要并发症发生率,改善患者营养状况,缩短住院时间。
Objective To investigate the optimal timing,prognostic benefits and influencing factors of awake extracorporeal membrane oxygenation(ECMO)in patients following cardiac surgery.Methods The clinical data of 56 patients with“awake ECMO”after cardiac surgery from January 2022 to June 2024 in Xijing Hospital were retrospectively analyzed.Patients were categorized into a fully awake group(no mechanical ventilation during ECMO)and a non-fully awake group(mechanical ventilation required during ECMO).The non-fully awake group was further stratified into an early awake subgroup(mechanical ventilation duration<40%of total ECMO support time)and a non-early awake subgroup(mechanical ventilation duration≥40%).The baseline data,extubation factors and clinical outcomes were compared between groups.Multivariate analysis was performed to identify predictors of early tracheal extubation in the non-fully awake group.Results The fully awake group exhibited significantly higher hospital survival rates compared to the non-fully awake group(P=0.04).The fully awake group also demonstrated shorter total mechanical ventilation time,reduced ICU stays,shorter hospitalization,and lower rates of major complications In the non-fully awake group,the early awake subgroup achieved higher survival rates and lower complication rates(P<0.001).Albumin and prealbumin significantly improved during awake ECMO compared to tracheal intubation(P<0.05).Multivariate analysis identified postoperative pulmonary complications and oxygenation index as independent predictors of successful awake ECMO implementation.Conclusion Early awake V-A ECMO in post-cardiac surgery patients is associated with improved survival,reduced complications,enhanced nutritional status,and shorter hospital stays.
作者
罗建超
翟蒙恩
卢林鹤
吕向妮
刘金成
刘洋
Luo Jianchao;Zhai Mengen;Lu Linhe;Lyu Xiangni;Liu Jincheng;Liu Yang(Department of Cardiovascular Surgery,the First Affiliated Hospital of the Air Force Medical University,Shaanxi Xi’an 710032,China)
出处
《中国体外循环杂志》
2025年第4期295-301,353,共8页
Chinese Journal of Extracorporeal Circulation
基金
国家自然科学基金(82370273)
国家重点研发计划(2023ZD0504400)
西京医院交叉项目(XJZT24JC37)
空军后勤自主科研项目(CKJ23WS2C008)。
关键词
清醒
动脉-静脉
体外膜氧合
心脏外科手术
心源性休克
Awake
Veno-arterial
Extracorporeal membrane oxygenation
Cardiac Surgery
Cardiogenic shock
