心源性休克采用体外膜肺氧合支持的相关危险因素分析

目的探讨体外膜肺氧合（ECMO）不良预后的独立预测因子。方法以回顾性方法序贯入选2009--2012年心脏术后或急性心肌梗死后心源性休克并于ECMO辅助的患者，对其采用统一的监测与管理方法，从而获取数据资料，并采用t检验及多因素Logistic回归分析的方法比较患者存活与死亡的各项变量。结果在入选的29例患者中，7例患者不能撤离ECMO，占总数的24．1％，而在成功撤离ECMO的22例患者中，仍有5例患者不能存活，占总数的22．7％。死亡患者平均年龄（60±12）岁，存活患者（51±11）岁，二者比较差异有统计学意义（P〈0．05），ECMO辅助24h后的高乳酸水平死亡组：（6．8±2．7）mmol／L，存活组：（2．3±1．8）mmol／L，P〈0．01]、长时间ECMO辅助死亡组：（81±52）h，存活组：（61±37）h，P〈0．01]也是不良预后的相关危险因素。结论年龄是评估心外手术后或急性心肌梗死后心源性休克患者是否能从ECMO获益的独立预测因子，血乳酸水平是ECMO治疗后不良预后的有效预测因子。

Analysis of the relevant risk factors of cardic shock patients with extracorporeal membrane oxygenation

Objective To investigate extracorporeal membrane oxygenation （ECMO） related predictors of all-cause mortality. Methods The data was retrospectively obtained from our hospital patient database. All 29 pa- tients received ECMO support from 2009 to 2012 who unified the criterion of intensive care and management. T-test and muhivariate Logistic regression analysis were performed to compare the variables of survivors and nonsurvivors. Results There were 7 patients （24.1% ） of a total 29 patients who could not wean from ECMO; after weaning, still 5 patients （22.7%） of total 22 patients could not survive. Age in survivors and nonsurvivors had significant difference （51 ±11 ） years old vs （ 60 ± 12 ） years old, P 〈 0. 05 ] and great lactate levels after 24 h of ECMO therapy nonsurvivors ： （ 81 ± 52 ） h, survivors ： （ 61 ± 37 ） h, P 〈 0. 01 ], a longer duration of ECMO support were in- dependent predictive factors for mortality. Conclusion Age appears to be an essential preoperative predictor for mortality and the blood lactate level is a relevant marker for the assessment of efficient ECMO support.