体外膜肺氧合联合主动脉内球囊反搏抢救心源性休克的影响因素

doi:10.3969/j.issn.1004-583X.2025.11.002

摘要/Abstract

摘要：

目的探究影响体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)联合主动脉内球囊反搏泵(intra-aortic balloon pump,IABP)抢救心源性休克(cardiogenic shock,CS)患者救治成功的影响因素。方法选取2018年12月-2023年12月于郑州大学附属郑州中心医院心脏监护病房住院的抢救时应用静脉-动脉ECMO联合IABP辅助心肺的CS患者40例。根据抢救是否成功分为存活组(n=17)和死亡组(n=23)。收集并分析两组临床资料,采用logistic回归分析探讨影响救治成功的影响因素。结果存活组年龄、血气分析中最高乳酸水平、恢复自主心律时间、入院时丙氨酸转氨酶水平均小于死亡组(P<0.05)。其中存活组原发病全部解决,死亡组21.7%患者原发病解决,差异有统计学意义(P<0.05)。两组抢救时出现恶性心律失常占比、住院期间最差左心室射血分数水平差异均无统计学意义(P>0.05)。单因素logistic回归分析显示,恢复自主心律时间越长、血气分析中最高乳酸越高和年龄越大,死亡风险越高(P<0.05,OR>1),血气分析中最低标准剩余碱和最低pH越高,死亡风险越低(P<0.05,OR<1)。结论采用ECMO联合IABP抢救CS患者时,及时解决原发病可能是抢救成功的关键,缩短恢复自主心律时间,维持内环境稳定可能是抢救成功的重要组成部分。

关键词: 休克, 心源性, 体外膜肺氧合, 主动脉内气囊泵, 抢救

Abstract:

Objective To investigate the factors influencing the success of rescue using extracorporeal membrane oxygenation (ECMO) combined with an intra-aortic balloon pump (IABP) in patients with cardiogenic shock (CS). Methods A total of 40 CS patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) combined with IABP for cardiopulmonary support during rescue in the Cardiac Care Unit of Zhengzhou Central Hospital Affiliated to Zhengzhou University between December 2018 and December 2023 were selected. Based on rescue outcomes, patients were divided into the survival group (n=17) and the death group (n=23). Clinical data of both groups were collected and analyzed. Logistic regression analysis was used to explore the factors influencing the successful rescue. Results Patients in the survival group had significantly lower age, lactate levels, time to restoration of spontaneous rhythm, and alanine aminotransferase (ALT) levels on admission compared to the death group (P<0.05). The primary disease was resolved in 100% of patients in the survival group and 21.7% in the death group, showing a significant difference (P<0.05). No significant differences were found between the two groups in the proportion of malignant arrhythmias occurring during rescue and the worst left ventricular ejection fraction (LVEF) levels during hospitalization (P>0.05). Univariate logistic regression analysis showed that longer time to restore spontaneous rhythm, higher maximum lactic acid in blood gas analysis and older age predicted a higher risk of death(P<0.05,OR>1). The higher minimum standard residual base and higher minimum pH in blood gas analysis predicted a lower risk of death (P<0.05, OR<1). Conclusion When using ECMO combined with IABP to rescue CS patients, timely resolution of the primary disease may be key to successful rescue. Shortening the time to restore spontaneous rhythm and maintaining internal homeostasis may be important components of successful rescue.

Key words: shock, cardiogenic, extracorporeal membrane oxygenation, intra-aortic balloon pumping, rescue

中图分类号:

R542.22

石慧丽, 王佩佩, 马冬璞, 杨艳鹏. 体外膜肺氧合联合主动脉内球囊反搏抢救心源性休克的影响因素[J]. 临床荟萃, 2025, 40(11): 973-977.

Shi Huili, Wang Peipei, Ma Dongpu, Yang Yanpeng. Analysis of factors influencing extracorporeal membrane oxygenation combined with intra-aortic balloon pump in the treatment of cardiac shock[J]. Clinical Focus, 2025, 40(11): 973-977.

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https://www.lchc.cn/CN/Y2025/V40/I11/973

图/表 3

表1 两组临床资料比较

Tab.1 Comparison of clinical data between the two groups

项目	存活组( $n$ =17)	死亡组( $n$ =23)	统计值	$P$ 值
年龄(岁)	55.3±11.8	65.3±11.9	-2.647	0.012
女性[例(%)]	4(23.5)	8(34.8)	0.589	0.505
吸烟史[例(%)]	8(47.0)	12(52.2)	0.102	1.000
高血压病史[例(%)]	6(35.3)	12(52.2)	1.125	0.348
糖尿病史[例(%)]	4(23.5)	7(30.4)	0.234	0.730
冠心病史[例(%)]	4(23.5)	7(30.4)	0.234	0.730
脑卒中史[例(%)]	2(11.8)	7(30.4)	1.954	0.256
抢救时心肺复苏[例(%)]	13(76.5)	20(87.0)	0.744	0.432
出现恶性心律失常[例(%)]	14(82.4)	17(73.9)	0.399	0.707
解决原发病[例(%)]	17(100.0)	5(21.7)	24.190	0.000
血气分析中最低标准剩余碱	-11.2±4.3	-18.8±6.4	4.212	0.000
血气分析中最高乳酸(mmol/L)	11.06±4.4	17.04±6.9	-3.138	0.003
血气分析中最低pH	7.12±0.10	7.05±0.19	2.975	0.005
入院首次血糖(mmol/L)	13.56±5.51	12.69±7.02	0.420	0.677
恢复自主心律时间(min)	7.50(4.75, 20.50)	55.00(35.00,60.00)	-4.455	0.000
入院肌酐(μmol/L)	99.10(79.05, 12.4)	109.20(60.20, 142.40)	-0.150	0.892
入院ALT(U/L)	248.00(170.5, 427.5)	479.00(312.00, 2272.00)	-2.230	0.026
入院AST(U/L)	724.00(346.00, 1045.00)	925.00(925.00, 2823.00)	-1.272	0.203
住院期间最差LVEF(%)	30.00(26.00, 38.00)	30.00(25.00, 40.00)	-0.411	0.685

表1 两组临床资料比较

Tab.1 Comparison of clinical data between the two groups

项目	存活组( $n$ =17)	死亡组( $n$ =23)	统计值	$P$ 值
年龄(岁)	55.3±11.8	65.3±11.9	-2.647	0.012
女性[例(%)]	4(23.5)	8(34.8)	0.589	0.505
吸烟史[例(%)]	8(47.0)	12(52.2)	0.102	1.000
高血压病史[例(%)]	6(35.3)	12(52.2)	1.125	0.348
糖尿病史[例(%)]	4(23.5)	7(30.4)	0.234	0.730
冠心病史[例(%)]	4(23.5)	7(30.4)	0.234	0.730
脑卒中史[例(%)]	2(11.8)	7(30.4)	1.954	0.256
抢救时心肺复苏[例(%)]	13(76.5)	20(87.0)	0.744	0.432
出现恶性心律失常[例(%)]	14(82.4)	17(73.9)	0.399	0.707
解决原发病[例(%)]	17(100.0)	5(21.7)	24.190	0.000
血气分析中最低标准剩余碱	-11.2±4.3	-18.8±6.4	4.212	0.000
血气分析中最高乳酸(mmol/L)	11.06±4.4	17.04±6.9	-3.138	0.003
血气分析中最低pH	7.12±0.10	7.05±0.19	2.975	0.005
入院首次血糖(mmol/L)	13.56±5.51	12.69±7.02	0.420	0.677
恢复自主心律时间(min)	7.50(4.75, 20.50)	55.00(35.00,60.00)	-4.455	0.000
入院肌酐(μmol/L)	99.10(79.05, 12.4)	109.20(60.20, 142.40)	-0.150	0.892
入院ALT(U/L)	248.00(170.5, 427.5)	479.00(312.00, 2272.00)	-2.230	0.026
入院AST(U/L)	724.00(346.00, 1045.00)	925.00(925.00, 2823.00)	-1.272	0.203
住院期间最差LVEF(%)	30.00(26.00, 38.00)	30.00(25.00, 40.00)	-0.411	0.685

表2 单因素logistic回归析自变量和因变量的赋值

Tab.2 Assignment of independent variables and dependent variables in the univariate logistic regression analysis

变量	赋值
因变量(Y)
是否死亡	否=0,是=1
自变量(X)
年龄	连续变量
血气分析中最低标准剩余碱	连续变量
血气分析中最低pH	连续变量
血气分析中最高乳酸	连续变量
入院首次血糖	连续变量
恢复自主心律时间	连续变量
入院肌酐	连续变量
入院ALT	连续变量
入院AST	连续变量
住院期间最差LVEF	连续变量
性别	女性=0,男性=1
吸烟史	是=1,否=0
高血压病史	是=1,否=0
糖尿病史	是=1,否=0
冠心病史	是=1,否=0
脑卒中史	是=1,否=0
抢救时心肺复苏	是=1,否=0
出现恶性心律失常	是=1,否=0
解决原发病	是=1,否=0

表3 ECMO联合IABP抢救CS患者影响因素的单因素logistic回归析

Tab.3 Univariate logistic regression analysis of the influencing factors on the success of ECMO combined with IABP in rescuing CS patients

危险因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95%可信区间
危险因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.074	0.032	5.244	0.022	1.076	1.011	1.147
血气分析中最低标准剩余碱	-0.259	0.085	9.252	0.002	0.772	0.653	0.912
血气分析中最高乳酸	0.182	0.070	6.814	0.009	1.200	1.047	1.376
血气分析中最低pH	-5.899	2.502	5.556	0.018	0.003	0.000	0.370
恢复自主心律时间	0.188	0.072	6.834	0.009	1.207	1.048	1.389

表3 ECMO联合IABP抢救CS患者影响因素的单因素logistic回归析

Tab.3 Univariate logistic regression analysis of the influencing factors on the success of ECMO combined with IABP in rescuing CS patients

危险因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95%可信区间
危险因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.074	0.032	5.244	0.022	1.076	1.011	1.147
血气分析中最低标准剩余碱	-0.259	0.085	9.252	0.002	0.772	0.653	0.912
血气分析中最高乳酸	0.182	0.070	6.814	0.009	1.200	1.047	1.376
血气分析中最低pH	-5.899	2.502	5.556	0.018	0.003	0.000	0.370
恢复自主心律时间	0.188	0.072	6.834	0.009	1.207	1.048	1.389

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