摘要
目的 探讨静脉-静脉体外膜肺氧合(VV-ECMO)治疗重度急性呼吸窘迫综合征(ARDS)患者的效果及预后影响因素.方法 以回顾性研究方法选取100例重度ARDS患者,其中采用VV-ECMO治疗的50例患者作为研究组,采用高频振荡通气治疗的50例患者作为对照组.比较两组患者的氧合指标及预后;分析经VV-ECMO治疗重度ARDS患者预后的影响因素.结果 治疗24、72 h后,研究组的氧合指数、pH和动脉血氧分压(PaO2)均高于对照组,动脉血二氧化碳分压(PaCO2)、血乳酸水平和呼气末正压(PEEP)均低于对照组(P＜0.05).治疗后3个月,两组的存活率比较,差异无统计学意义(P＞0.05).研究组不同预后患者的年龄、ECMO之前机械通气时间、发病至ECMO时间、ECMO治疗时间、心率、平均动脉压(MAP)、血乳酸和降钙素原(PCT)水平比较,差异具有统计学意义(P＜0.05).Logistic回归分析结果显示,年龄、ECMO之前机械通气时间、发病至ECMO时间、血乳酸以及PCT是经VV-ECMO治疗重度ARDS患者预后不良的独立危险因素(P＜0.05).结论 VV-ECMO治疗可改善重度ARDS患者的氧合指标,且年龄、ECMO之前机械通气时间、发病至ECMO时间、血乳酸和PCT是患者预后的影响因素.
Abstract
Objective To investigate the effect and prognostic factors of veno-venous extracorporeal membrane oxygenation(VV-ECMO)in the treatment of patients with severe acute respiratory distress syndrome(ARDS).Methods A retrospective study was conducted to select 100 patients with severe ARDS,including 50 patients treated with VV-ECMO as study group and 50 patients treated with high-frequency oscillatory ventilation as control group.The oxygenation indexes and prognosis of the two groups were compared;the prognostic factors of patients with severe ARDS treated by VV-ECMO were analyze.Results After 24 and 72 h of treatment,the oxygenation index,pH and arterial blood oxygen partial pressure(PaO2)in the study group were higher than those in the control group,and arterial blood carbon dioxide partial pressure(PaCO2),blood lactic acid level and positive end-expiratory pressure(PEEP)were lower than those in the control group(P＜0.05).At 3 months after treatment,there was no significant difference in the survival rate between the two groups(P＞0.05).There were statistically significant differences in age,mechanical ventilation time before ECMO,time from onset to ECMO,ECMO treatment time,heart rate,mean arterial pressure(MAP),blood lactic acid and procalcitonin(PCT)levels among patients with different prognosis in the study group(P＜0.05).Logistic regression analysis results showed that age,mechanical ventilation time before ECMO,time from onset to ECMO,blood lactic acid and PCT were independent risk factors for poor prognosis in patients with severe ARDS treated by VV-ECMO(P＜0.05).Conclusion VV-ECMO treatment can improve the oxygenation index of patients with severe ARDS,and age,mechanical ventilation time before ECMO,time from onset to ECMO,blood lactic acid and PCT are the influencing factors of prognosis.
NETL
NSTL
万方数据