摘要
目的:分析美国心血管造影与介入学会(society for cardiovascular angiography and interventions,SCAI)休克分级与静脉-动脉体外膜氧合(venoarterial extracorporeal membrane oxygenation,VA ECMO)支持难治性心源性休克(refractory cardiogenic shock,RCS)患者临床结局的相关性。方法:回顾性分析2017年1月1日至2021年12月31日期间,北京安贞医院VA ECMO支持的RCS患者,根据心源性休克工作组(cardiogenic shock working group,CSWG)共识制定的SCAI休克分级方法对患者进行分组,分别就患者的基本信息、ECMO前基线条件和临床结局比较组间差异。研究的主要终点为出院死亡率,次要终点为ECMO撤除率和30d死亡率。结果:395例患者被纳入研究,中位年龄62(54,67)岁,男性占71.9%。在VA ECMO辅助前,处在SCIA休克分级B级的患者有49例(12.4%),C级78例(19.7%),D级65例(16.5%),E级203例(51.4%)。SCAI休克分级是患者住院期间死亡的危险因素,死亡率随分级的升高逐级递增,以SCAI B级为参考,C级:OR=1.509,95%CI:0.703~3.238;D级:OR=2.752,95%CI:1.233~6.142;E级:OR=3.271,95%CI:1.653~6.474,P<0.001;ECMO前心功能NYHA III级以上也是患者死亡的危险因素(OR=2.538,95%CI:1.564~4.119,P<0.001);相反,罹患心肌炎则是此类患者住院生存的保护性因素(OR=0.133,95%CI:1.564~4.119,P=0.012)。SCAI E级患者的ECMO撤除率和住院死亡率均高于B、C级患者,差异有统计学意义(P<0.001)。随着SCAI休克分级的升高,连续肾替代治疗(continuous renal replacement treatment,CRRT)的使用率增加,差异有统计学意义(P<0.001)。处在C级患者的ECMO支持时间、机械通气时间和住院时间最长,其次是D级,ICU时间从C级到E级逐渐减少(P<0.001)。结论:SCAI休克分级是VA ECMO支持心源性休克患者住院死亡的危险因素。
Objective:To analyze the correlation between the society for cardiography and Interventional therapy(SCAI)shock stage and the clinical outcome of patients with refractory cardiogenic shock(RCS)supported by veno-arterial extracorporeal membrane oxygenation(VA ECMO).Methods:Retrospective analysis was performed on VA ECMO-supported RCS patients from Beijing Anzhen Hospital from January 1st 2017 to December 31st 2021.Patients were divided into different groups according to the SCAI shock classification method developed by the consensus of the working group on cardiogenic shock(CSWG).The differences between groups were compared in terms of basic information,baseline conditions before ECMO and clinical outcomes.The primary end point was discharge mortality,and secondary end points were ECMO removal rate and 30-day mortality.Results:Three hundred and ninety-five patients were finally included in the study,among which the median age was 62(54,67)years and 71.9%were males.Before VA ECMO,49 patients(12.4%)were in SCIA Stage B,78(19.7%)in Stage C,65(16.5%)in Stage D and 203(51.4%)in Stage E.The mortality increased incrementally with the SCAI classification,which was an independent risk factor for in-hospital mortality:Stage C(OR=1.509,95%CI:0.703-3.238),Stage D(OR=2.752,95%CI:1.233-6.142)and Stage E(OR=3.271,95%CI:1.653-6.474,P<0.001),when compared with Stage B.NYHA grade higher than III was also an independent risk factor for death(OR=2.538,95%CI:1.564-4.119,P<0.001),while the diagnosis of myocarditis was associated with lower in-hospital mortality(OR=0.13,95%CI:1.564-4.119,P=0.012).The rate of ECMO removal and in-hospital mortality of SCAI grade E patients were higher than those of B and C patients,the difference was significant(P<0.001).The use of continuous renal replacement treatment(CRRT)increased with the increase of SCAI shock grade,with significant inter-group differences(P<0.001).Patients in Grade C had the longest ECMO duration,mechanical ventilation time,and hospital stay,followed by grade D,and ICU time decreased gradually from grade C to grade E(P<0.001).Conclusions:SCAI shock classification before ECMO initiation is an independent risk factor for in-hospital mortality in CS patients undergoing VA ECMO support.
作者
江瑜
李呈龙
谢海秀
杨峰
王晓朦
庄晓莉
杨晓芳
关明
黑飞龙
侯晓彤
JIANG YU;LI Chenglong;XIE Haixiu;YANG Feng;WANG Xiaomeng;ZHUANG Xiaoli;YANG Xiaofang;GUAN Ming;HEI Feilong;HOU Xiaotong(Department of Extracorporeal Circulation and Mechanical Circulatory Support,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)
出处
《心肺血管病杂志》
CAS
2023年第6期593-599,共7页
Journal of Cardiovascular and Pulmonary Diseases
关键词
难治性心源性休克
心血管造影与介入学会休克分级
缩血管药
体外膜氧合
机械循环辅助
Refractory cardiac shock
Society for Cardiovascular Angiography and Interventions shock classification
Vasopressors
Extracorporeal membrane oxygenation
Mechanical circulatory support
