摘要
目的评估体外生命支持(ECLS)桥接左心室辅助装置(LVAD)对心源性休克(CS)患者心脏支持状态和临床结局的影响。方法回顾性分析2015年8月至2024年6月在武汉市第一医院接受ECLS治疗并桥接到LVAD系统的20例机械辅助循环支持机构间注册(INTERMACS)Ⅰ级或Ⅱ级患者的临床资料。最长持续随访1337 d,主要终点是总死亡率,次要终点包括随访180 d LVAD支持情况及LVAD植入后第3天血流动力学、肝功能、心肌损伤标记物水平的变化。结果与ECLS治疗前比较,LVAD植入前患者pH、动脉血氧分压(PaO_(2))/吸入氧浓度(FiO_(2))、总胆红素、天冬氨酸转氨酶(AST)水平均略有升高(P均<0.05);而LVAD治疗后乳酸水平、FiO_(2)、PaO_(2)/FiO_(2)、肌酸激酶(CK)水平均显著降低(P均<0.001),而pH升高(P<0.05)。与LVAD植入前相比,LVAD植入第3天患者pH及总胆红素、AST水平均略有降低(P均<0.05),而乳酸水平显著降低(P<0.001),PaO_(2)/FiO_(2)略有升高(P<0.05)。在中位随访时间111.5 d(6~1337 d)内,6例(30.0%)患者死亡,其中5例患者随访30 d内死亡。随访180 d时,14例存活患者中有13例(92.9%)仍在接受LVAD,LVAD的中位持续时间为688.0 d(10~1337 d)。经Cox回归和LASSO-Cox回归分析,LVAD植入前CI和ΔPaO_(2)/FiO_(2)(LVAD植入前PaO_(2)/FiO_(2)-LVAD植入后第3天PaO_(2)/FiO_(2))与患者死亡独立相关(P<0.05)。结论在ECLS后桥接LVAD植入可使CS患者(INTERMACSⅠ级/Ⅱ级)获得理想的生存率,能够从ECLS的INTERMACSⅢ级临时机械循环支持初始稳定中受益,并可能避免双心室支持需求。
Objective To assess the impact of extracorporeal life support(ECLS)bridging to left ventricular assist device(LVAD)implantation on cardiac support status and clinical outcomes in patients with cardiogenic shock(CS).Methods Clinical data of 20 patients with INTERMACS classⅠorⅡtreated with ECLS and bridged to the LVAD system at Wuban First Hospital between August 2015 and June 2024 were retrospectively analyzed.The longest continuous follow-up of the study was 1,337 days,and the primary endpoint was total mortality,while secondary endpoints included LVAD support at 180 days of discharge and changes in hemodynamic parameters,liver function,and levels of markers of myocardial injury on day 3 after LV AD implantation.Results Compared with before ECLS treatment,pH,artial pressure of oxygen(PaO_(2))/inhaled oxygen concentration(FiO),total bilirubin,and glutamate aminotransferase(GOT)were slightly elevated before LVAD treatment(P<0.05);whereas,after LVAD treatment,lactate,FiO_(2),PaO_(2)/FiO_(2),and creatine kinase(CK)were significantly decreased(P<0.05),whereas pH was elevated(P<0.05).Compared with pre-LVAD treatment,pH,total bilirubin,GOT,andCK were slightly decreased(P<0.05),whereas lactate was significantly decreased(P<0.001),and PaO_(2)/FiO_(2)was slightly increased(P<0.05)compared with pre-LVAD treatment in patients after LVAD.Within a median time of 111.50 days(range:6 to 1,337 days),6(30.0%)patients died,with 5 occurring within 30 days.At 180 days,13(92.86%)of the 14 surviving patients were stillreceiving LVADsupport,and the median duration of LVAD support was 687.95 days(range:10 to 1337 days).After Cox regression and LASSO-COX regression analysis,pre-LVAD CI and PaO_(2)/FiO_(2)(pre-LVAD treatment PaO_(2)/FiO_(2)-3-day post-LVAD treatment PaO/FiO_(2))were independently associated with death(P<0.O5).Conclusions Bridging LVAD implantation after ECLSresults in excellent survival in patients with CS(INTERMACS ClassⅠandⅡ),the ability to benefit from initial stabilization of INTERMACSⅡTCS with ECLS,and avoidance of biventricular support.
作者
罗雨佳
杨力
叶晓
李莹
余志华
LUO Yujia;YANG Li;YE Xiao;LI Ying;YU Zhihua(Department of Cardiovascular Medicine,Wuhan First Hospital,Wuhan 430022,Hubei,China)
出处
《中国分子心脏病学杂志》
2025年第4期6928-6934,共7页
Molecular Cardiology of China
基金
湖北省卫生健康委科研项目(WJ2022F023)。
关键词
左心室辅助装置
体外生命支持
心源性休克
Left Ventricular Assist Device
Extracorporeal Life Support
Cardiogenic Shock
