Page 40 - 南京医科大学学报自然科学版

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