重症急性呼吸窘迫综合征的治疗：体外气体交换的作用
Treatment of severe acute respiratory distress syndrome: role of extracorporeal gas exchange.
作者信息
Beiderlinden Martin, Eikermann Matthias, Boes Tanja, Breitfeld Christa, Peters Jürgen
机构信息
Universitätsklinikum Essen, Klinik für Anästhesiologie und Intensivmedizin, Hufelandstrasse 55, 45122 Essen, Germany.
出版信息
Intensive Care Med. 2006 Oct;32(10):1627-31. doi: 10.1007/s00134-006-0262-y. Epub 2006 Jul 28.
OBJECTIVE
To evaluate the effect of extracorporeal gas exchange (ECMO) on mortality of patients referred with severe acute respiratory distress syndrome (ARDS).
DESIGN AND SETTING
Prospective observational study in a university hospital ICU.
PATIENTS
150 patients with severe ARDS.
INTERVENTIONS
Multimodal treatment with and without ECMO.
MEASUREMENTS AND MAIN RESULTS
We treated 118 patients (78.7%) conservatively and 32 patients with ECMO. Patients in the ECMO group presented with significantly more severe disease (lung injury score 3.8+/-0.3 vs. 3.3+/-0.4; SOFA score 52+/-14 vs. 43+/-12; and SAPS score 14+/-3.3 vs. 10+/-3.5). Mortality in ECMO-treated patients tended to be higher than that with conservative treatment (46.9% vs. 28.8%, p=0.059). Multivariate logistic regression analyses with backward selection excluded ECMO as predictor of mortality (p=0.79). Independent predictors of mortality were age (odds ratio 1.044, 95% confidence interval 1.014-1.075, p=0.004), mean pulmonary artery pressure (1.082, 1.026-1.141, p=0.036), sequential organ failure assessment score (1.148, 1.018-1.294, p=0.024), and days of mechanical ventilation prior to referral (1.064, 1.008-1.123, p=0.025).
CONCLUSION
ECMO treatment does not predict mortality in patients with most severe ARDS.
目的
评估体外气体交换（ECMO）对因严重急性呼吸窘迫综合征（ARDS）转诊患者死亡率的影响。
设计与背景
在一所大学医院重症监护病房进行的前瞻性观察性研究。
患者
150例严重ARDS患者。
干预措施
采用多模式治疗，部分患者接受ECMO治疗，部分患者未接受。
测量指标与主要结果
我们对118例患者（78.7%）进行了保守治疗，32例患者接受了ECMO治疗。ECMO组患者的病情明显更严重（肺损伤评分3.8±0.3对3.3±0.4；序贯器官衰竭评估（SOFA）评分52±14对43±12；简化急性生理学评分（SAPS）14±3.3对10±3.5）。接受ECMO治疗患者的死亡率倾向于高于保守治疗患者（46.9%对28.8%，p = 0.059）。采用向后选择的多因素逻辑回归分析排除ECMO作为死亡率的预测因素（p = 0.79）。死亡率的独立预测因素为年龄（比值比1.044，95%置信区间1.014 - 1.075，p = 0.004）、平均肺动脉压（1.082，1.026 - 1.141，p = 0.036）、序贯器官衰竭评估评分（1.148，1.018 - 1.294，p = 0.024）以及转诊前机械通气天数（1.064，1.008 - 1.123，p = 0.025）。
结论
ECMO治疗不能预测最严重ARDS患者的死亡率。
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