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南京医科大学学报(自然科学版) 第43卷第12期
·1656 · Journal of Nanjing Medical University(Natural Sciences) 2023年12月
·临床研究·
ECPR患者ECMO支持早期发作室颤/室速与预后关系
周 浩 ,李 伟 ,朱 轶 ,张忠满 ,陈旭锋 ,吕金如 1*
1
1
1
1
1,2
南京医科大学第一附属医院急诊与危重病医学科,江苏 南京 210029;海南医学院急救与创伤研究教育部重点实验室,海
1 2
南 海口 571199
[摘 要] 目的:回顾分析体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)患者在体外膜肺氧合(extracorpo⁃
real membrane oxygenation,ECMO)早期(72 h内)的室颤/室速(ventricular fibrillation/ventricular tachycardia,VF/VT)发生率、危险
因素及对预后的影响。方法:纳入2017年1月—2023年3月南京医科大学第一附属医院急诊中心的ECPR患者,根据ECMO运
行72 h内是否发作VF/VT分为VF/VT组和nVF/VT组,回归分析ECMO支持下VF/VT发作的危险因素,并探究VF/VT对临床预
后的影响。结果:95例患者,年龄(50.02±15.93)岁,其中男66.32%,28 d存活率51.58%,VF/VT的发生率为33.33%。组间比较
显示,nVF/VT 组持续性肾替代治疗使用率、ECMO启动时间、乳酸均高于VF/VT组,VF/VT肌钙蛋白T(troponin T,TnT)呈高水
平趋势;VF/VT组的pH值显著低于nVF/VT组。逐步法多因素Logistic回归显示,发生VF/VT后,TNT维持高水平的风险显著增
大(OR=18.156,95%CI:3.620~91.059);ECMO启动时间延长(OR=1.118,95%CI:1.060~1.180)和pH值下降(OR=0.005,95%CI:
0.000~0.953)是VF/VT发生的独立危险因素。结论:在ECPR患者中,严重酸中毒或ECMO启动时间延长的患者在ECMO支持
72 h内发生VF/VT的风险明显增加,VF/VT发作并不影响主要临床预后,但可能会加重心肌损伤。
[关键词] 体外心肺复苏;体外膜肺氧合;心室颤动/室性心动过速;预后
[中图分类号] R459.7 [文献标志码] A [文章编号] 1007⁃4368(2023)12⁃1656⁃08
doi:10.7655/NYDXBNS20231206
Relationship between early onset ventricular fibrillation/ventricular tachycardia and
prognosis in ECPR patients with ECMO support
1,2 1 1 1 1 1*
ZHOU Hao ,LI Wei ,ZHU Yi ,ZHANG Zhongman ,CHEN Xufeng ,LÜ Jinru
1
Department of Emergency and Critical Care Medicine,the First Affiliated Hospitalof Nanjing Medical University,
2
Nanjing 210029;Key Laboratory of Emergency and Trauma of Ministry of Education,Hainan Medical University,
Haikou 571199,China
[Abstract] Objective:To retrospectively analyzethe incidence,risk factors,and prognosis of ventricular fibrillation/ventricular
tachycardia(VF/VT)within 72 hours of extracorporeal cardiopulmonary resuscitation(ECPR)in patients supported by extracorporeal
membrane oxygenation(ECMO). Methods:ECPR patients admitted to the Emergency Center of the First Affiliated Hospital of Nanjing
Medical University from January 2017 to March 2023 were included. Patientswere divided into VF/VT group and nVF/VT group
according to the occurrence of VF/VT within 72 hours of ECMO support. risk factors for VF/VT during ECMO support were analyzed
through regression analysis,and the impact of VF/VT on clinical prognosis was explored. Results:A total of 95 patients with a mean
age of(50.02±15.93)years were enrolled,with males accounting for 66.32%. The 28⁃day survival rate was 51.58%,and the incidence
of VF/VT was 33.33%. Comparison among groups showed that the nVF/VT group had a higher rates of continuous renal replacement
therapy,longer ECMO initiation time,and higher lactic acidlevels compared tothe VF/VT group.Troponin T(TnT)levels showed a trend
of being higher in the VF/VT group,while the pH value was significantly lower in the VF/VT group compared to the nVF/VT group.
Stepwise multivariable logistic regression analysis showed that the risk of maintaining high TNT levels significantly increased after VF/
VToccurrence,with an odds ratio(OR)of 18.156(95%CI:3.620-91.059). Prolonged ECMO initiation time(OR=1.118,95%CI:1.060-
1.180)and decreased pH value(OR=0.005,95%CI:0.000-0.953)were identified as independent risk factors for VF/VT occurrence.
Conclusion:In patients with ECPR,the risk of VF/VT occurring within 72 hours of ECMO support issignificantly increased in patients
with severe acidosis or prolonged ECMO initiation time. The onset of VF/VT does not affect the clinical prognosis but may exacerbate
[基金项目] 急救与创伤研究教育部重点实验室海南医学院开放基金课题(KLET⁃202120)
∗
通信作者(Corresponding author),E⁃mail:hathe_YY_617@163.com