同时接受体外膜氧合器和连续性肾脏替代治疗患者的临床特点分析

Analysis of clinical characteristics of patients undergoing renal replacement therapy during extracorporeal membrane oxygenerator

摘要:

目的 探讨同时接受体外膜氧合器（ECMO）和连续性肾脏替代治疗（CRRT）患者的临床特点。方法 单中心回顾性分析2015年1月—2021年12月四川省人民医院重症医学科（ICU）同时接受ECMO联合CRRT治疗患者的临床资料，比较患者的原发疾病构成及病死率情况。结果 共纳入患者66例，生存者24例，死亡者42例。ECMO辅助治疗的患者中有30.13%同时接受了CRRT治疗，而联合CRRT治疗的患者病死率高达63.64%，其中肺移植、肺动脉栓塞、ECMO辅助下心肺复苏（ECPR）、神经源性休克患者预后较差，而重症心肌炎患者预后良好，住院病死率为33.33%，应激性心肌病、心脏术后低心排血量综合征、急性冠脉综合征、重症肺炎患者的病死率分别是0.00%、57.14%、62.50%和70.83%。66例患者最常见的并发症为出血（43.94%），其中消化道出血最常见，发生率为31.82%；其次是院内感染，发生率为37.88%，其中血流感染的发生率为27.27%。而行ECMO治疗第1天的液体平衡是重症肺炎患者的死亡危险因素；启动CRRT治疗时血肌酐是重症心肌炎患者的死亡危险因素。结论 ECMO患者中同时接受CRRT治疗的比例高，预后差，其中重症心肌炎、应激性心肌病、心脏术后低心排血量综合征、急性冠脉综合征患者预后相对较好，而出血和院内感染仍然是最常见的并发症，不同疾病的死亡危险因素不同。

Abstract:

Objective To investigate the prognosis of patients receiving extracorporeal membrane oxygenerator (ECMO) and renal replacement therapy (CRRT) at the same time.Methods The clinical data of patients treated with ECMO and CRRT in the intensive care unit (ICU) of Sichuan Provincial People's Hospital from January 2015 to December 2021 were retrospectively analyzed.Results A total of 66 cases were included, 24 cases survived, and 42 cases died. 30.13% of the patients treated with ECMO received CRRT at the same time, while the mortality rate of patients treated with CRRT was as high as 63.63%. The prognosis of patients with lung transplantation, pulmonary embolism, ECPR, and neurogenic shock was poor, while the prognosis of patients with severe myocarditis was better, and the in-hospital mortality rate was 33.33%. The mortality rates of patients with stress cardiomyopathy, low cardiac output after cardiac surgery, acute coronary syndrome and severe pneumonia were 0.00%, 57.14%, 62.50%, and 70.83%, respectively. The most common complication of 66 patients was bleeding (43.94%), of which gastrointestinal bleeding was the most common, with an incidence of 31.82%, followed by nosocomial infection with an incidence of 37.88%, of which the incidence of bloodstream infection was 27.27%. The fluid balance and bleeding complications on the first day of ECMO treatment were the risk factors of death in patients with severe pneumonia, and the level of serum creatinine at the start of CRRT treatment was the risk factor of death in patients with severe myocarditis.Conclusion The proportion of ECMO patients treated with CRRT is high and the prognosis is poor. The prognosis of patients with severe myocarditis, stress cardiomyopathy, low cardiac output after cardiac surgery and acute coronary syndrome is relatively satisfied, while bleeding and nosocomial infection are still the most common complications. The risk factors of death are different in different diseases.