摘要
【目的】探讨影响老年心源性休克(CGS)患者体外膜肺氧合(ECMO)治疗预后的影响因素。【方法】选取2018年1月至2021年2月韩城市人民医院及西安市红会医院阎良院区收治的124例老年CGS患者,均行ECMO治疗。记录患者ECMO治疗后90 d预后情况,并据此分为生存组与死亡组,分析老年CGS患者ECMO治疗预后的影响因素及SOFA评分、血乳酸、cTnT对预后的影响,评价SOFA评分、血乳酸、cTnT单独及联合检测对预后的预测价值。【结果】124例老年CGS患者ECMO治疗后90 d的生存率为75.81%,病死率为24.19%。单因素分析显示,病死组年龄>75岁、入ICU至ECMO时间≥5 h、急性肾损伤及ECMO治疗前SOFA评分、血乳酸、cTnT均高于生存组,ECMO治疗前LVEF低于生存组(P<0.05)。多因素分析显示,年龄、入ICU至ECMO时间、急性肾损伤、ECMO治疗前LVEF、SOFA评分、血乳酸、cTnT均为老年CGS患者ECMO治疗预后的影响因素(P<0.05)。ECMO治疗前SOFA评分、血乳酸、cTnT预测老年CGS患者ECMO治疗预后的曲线下面积(AUC)均>0.7,各指标联合预测的AUC最大,为0.947,最佳预测敏感度、特异度分别为86.67%、90.43%。【结论】老年CGS患者采用ECMO治疗效果较好,治疗前SOFA评分、血乳酸、cTnT联合检测对患者预后具有较高预测价值。
【Objective】To investigate the prognostic factors of extracorporeal membrane oxygenation(ECMO)in elderly patients with cardiogenic shock(CGS).【Methods】A total of 124 elderly patients with CGS treated in Hancheng people's Hospital and Yanliang Hospital of Xi'an Honghui hospital from January 2018 to February 2021 were treated with ECMO.The prognosis of patients 90 days after ECMO treatment was recorded and divided into survival group and death group.The influencing factors of ECMO treatment prognosis,the effects of SOFA score,blood lactic acid and cTnT on the prognosis of elderly CGS patients were analyzed,and the value of SOFA score,blood lactic acid and cTnT alone and in combination in predicting the prognosis was evaluated.【Results】The 90 day survival rate of 124 elderly patients with CGS after ECMO treatment was 75.81%,and the mortality was 24.19%.Univariate analysis showed that the age of death group>75 years old,the time from ICU to ECMO≥5 hours,acute renal injury,SOFA score,blood lactic acid and cTnT before ECMO treatment were higher than those in survival group,and LVEF before ECMO treatment was lower than those in survival group(P<0.05).Multivariate analysis showed that age,time from ICU to ECMO,acute renal injury,LVEF,SOFA score,blood lactic acid and cTnT before ECMO treatment were the influencing factors of the prognosis of elderly patients with CGS after ECMO treatment(P<0.05).Before ECMO treatment,the area under the curve(AUC)of SOFA score,blood lactic acid and cTnT to predict the prognosis of elderly CGS patients after ECMO treatment was>0.7.The AUC predicted by the combination of various indexes was the largest,which was 0.947.The best prediction sensitivity and specificity were 86.67%and 90.43%respectively.【Conclusion】ECMO is effective in the treatment of elderly patients with CGS.The combination of SOFA score,blood lactic acid and cTnT before treatment is of high value in predicting the prognosis of patients.
作者
刘剑虹
严红芳
LIU Jian-hong;YAN Hong-fang(Department of Cardiovascular Medicine,Hancheng people's hospital,Weinan Shaanxi 715401)
出处
《医学临床研究》
CAS
2022年第5期725-728,共4页
Journal of Clinical Research
关键词
休克
心源性/治疗
体外膜氧合作用
老年人
预后
Shock,Cardiogenic/TH
Extracorporeal Membrane Oxygenation
Aged
Prognosis
