体外膜肺氧合期间允许性低氧血症是否会导致长期神经功能障碍？：一项甲型 H1N1 流感引起的严重呼吸衰竭患者的研究。

Does permissive hypoxaemia during extracorporeal membrane oxygenation cause long-term neurological impairment?: A study in patients with H1N1-induced severe respiratory failure.

机构信息

From the ECMO Department Karolinska, Karolinska University Hospital and Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine (BH, VvB), Department of Psychology, Karolinska University Hospital, Huddinge and Department of Clinical Neuroscience (CA) ECMO Department Karolinska (HK, KP, BF), Department of Neuroradiology, Karolinska University Hospital, Stockholm (MM), Department of Surgical Sciences, Radiology, Uppsala University (E-ML), Department of Surgical Sciences, Anesthesiology and Intensive Care and Hedenstierna Laboratory, Uppsala University Hospital, Uppsala (AL), Sweden.

出版信息

Eur J Anaesthesiol. 2017 Feb;34(2):98-103. doi: 10.1097/EJA.0000000000000544.

DOI:10.1097/EJA.0000000000000544

PMID:28030441

Abstract

BACKGROUND

The Extracorporeal Life Support Organisation accepts permissive hypoxaemia in adult patients during extracorporeal membrane oxygenation (ECMO). The neurological long-term outcome of this approach has not yet been studied.

OBJECTIVES

We investigated the prevalence of brain lesions and cognitive dysfunction in survivors from the Influenza A/H1N1 2009 pandemic treated with permissive hypoxaemia during ECMO for severe acute respiratory distress syndrome (ARDS). Our hypothesis was that this method is reasonable if tissue hypoxia is avoided.

DESIGN

Long-term follow-up study after ECMO.

SETTING

Karolinska University Hospital, Sweden, from October 2012 to July 2013.

PATIENTS

Seven patients treated with ECMO for severe influenza A/H1N1-induced ARDS were studied 3.2 years after treatment. Blood lactate concentrations were used as a surrogate for tissue oxygenation.

INTERVENTIONS

Neurocognitive outcome was studied with standardised cognitive tests and MRI of the brain.

MAIN OUTCOME MEASURES

Cognitive functioning and hypoxic brain lesions after permissive hypoxaemia during ECMO. The observation period was the first 10 days of ECMO or the entire treatment period if shorter than 10 days.

RESULTS

Eleven of 13 patients were still alive 3 years after ECMO. We were able to contact seven of these patients (mean age 31 years), who all agreed to participate in this study. Mean ± SD peripherally measured arterial saturation during the observation period was 79 ± 10%. Full-scale Intelligence Quotient was within one standard deviation or above from the mean of a healthy population in five patients, and was 1.5 SD below the mean in one patient. In one other patient, it could not be determined because of a lack of formal education. Memory functioning was normal in all patients. MRI showed no changes related to cerebral hypoxia.

CONCLUSIONS

Permissive hypoxaemia during ECMO might not negatively affect long-term cognitive outcome if adequate organ perfusion is maintained.

TRIAL REGISTRATION

at Clinicaltrials.gov NCT01763060.

摘要

背景

体外生命支持组织（Extracorporeal Life Support Organisation）在体外膜氧合（extracorporeal membrane oxygenation，ECMO）治疗成人患者时接受允许性低氧血症。但这种方法的神经长期预后尚未得到研究。

目的

我们调查了甲型 H1N1 流感大流行期间接受 ECMO 治疗的严重急性呼吸窘迫综合征（ARDS）患者中，允许性低氧血症治疗后的幸存者中脑损伤和认知功能障碍的发生率。我们的假设是，如果避免组织缺氧，这种方法是合理的。

设计

ECMO 后进行的长期随访研究。

地点

瑞典卡罗林斯卡大学医院，2012 年 10 月至 2013 年 7 月。

患者

7 例因严重甲型 H1N1 流感引起的 ARDS 接受 ECMO 治疗的患者，在治疗后 3.2 年进行研究。血乳酸浓度被用作组织氧合的替代指标。

干预措施

使用标准化认知测试和脑部 MRI 评估神经认知结果。

主要观察指标

ECMO 期间允许性低氧血症后的认知功能和缺氧性脑损伤。观察期为 ECMO 的前 10 天或整个治疗期（如果短于 10 天）。

结果

13 例患者中有 11 例在 ECMO 后 3 年内仍存活。我们能够联系到这 7 名患者（平均年龄 31 岁），他们都同意参与这项研究。在观察期内，外周测量的动脉饱和度平均值为 79±10%。5 名患者的全智商均在健康人群平均值的一个标准差范围内或以上，1 名患者的智商为平均值的 1.5 个标准差以下。另一名患者由于缺乏正规教育，无法确定。所有患者的记忆功能均正常。MRI 未显示与脑缺氧相关的变化。