左心室功能参数监测经静脉-动脉体外膜肺氧合辅助患者心功能

目的 观察超声心动图监测经静脉-动脉模式体外膜肺氧合(V-AECMO)辅助患者左心室功能参数变化及预测脱机的价值.方法 回顾性分析18例接受V-A ECMO辅助治疗患者,根据脱机成功与否分为成功组12例、失败组6例;对比2组ECMO支持第1天、脱机前1天及脱机即刻左心室舒张末期容积(LVEDV)、收缩末期容积(LVES...

Left ventricular function parameters for monitoring cardiac function in patients assisted by venous-arterial extracorporeal membrane oxygenation

Objective To observe the value of echocardiography in monitoring changes of left ventricular function parameters and predicting weaning in patients assisted by veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Methods Data of 18 patients receiving V-A ECMO adjuvant therapy were retrospectively analyzed. According to whether the weaning was successful or not, the patients were divided into successful group (n=12) and failed group (n=6). The left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), velocity time integral (VTI) of left ventricular outflow tract, maximum forward flow velocity of aortic valve (AV-V_max), early peak mitral orifice diastolic flow velocity (E), tissue Doppler imaging mitral latera annular systolic velocity (TDI lat s'') and early diastolic septum wall site of mitral annular velocity (e'') acquired on the first day of ECMO support, the day before weaning and immediately after weaning were compared between groups, and E/e''was calculated. The left ventricular global longitudinal strain (LVGLS) and strain rate (LVGLSR) were measured with two-dimensional speckle tracking imaging. Results On the day before weaning, LVEF, TDI lat s'', AV- V_max, VTI, LVGLS and LVGLSR in successful group were all significantly higher than those in failure group (all P<0.05), while the ECMO flow in successful group was significantly lower than t in failure group (P<0.05). LVEF, TDI lat s'', AV-V_max, VTI, LVGLS and LVGLSR of successful group on the day before weaning were significantly higher, but ECMO flow was lower than on the first day of ECMO support (all P<0.05). Immediately after weaning, LVEF, TDI lat s'', VTI and LVGLS further increased compared with those on the day before weaning (all P<0.05). The area under the curve (AUC)of successful weaning predicted by LVEF, TDI lat s'', AV-V_max, VTI and LVGLS on the one day before weaning was 0.926, 0.917, 0.861, 0.944 and 0.981, respectively. Taken 34.50%, 9.40 cm, 5.50 cm/s, -6.75% and 85.00 cm/s as cut-off values, the sensitivity was 88.90%, 88.90%, 77.80%, 100% and 88.90%, and specificity was 83.30%, 83.30%, 83.30%, 83.30% and 100%, respectively. Conclusion Echocardiography could real-time monitor patients receiving ECMO support, having important value for evaluating the efficacy of ECMO, selecting weaning time and predicting prognosis.