Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany.
Eur J Cardiothorac Surg. 2017 Aug 1;52(2):241-247. doi: 10.1093/ejcts/ezx100.
Information is lacking about long-term survival and quality of life (QOL) after treating patients on extracorporeal life support.
Outcome data were assessed by phone interviews, a QOL analysis using the EuroQol 5-dimensions questionnaire and a retrospective inquiry of the Regensburg ECMO Registry database for the decade 2006-2015. A statistical analysis was obtained by comparing patients with a cardiosurgical intervention (CS = 189 patients) with those without (w/oCS = 307 patients).
Survival to discharge in the w/oCS group was higher than that in the CS group (w/oCS: 41.7% vs CS: 29.5%; P = 0.004). A Kaplan-Meier analysis showed a significant difference between both groups in favour of patients w/oCS (log rank P = 0.02). This difference was no longer statistically significant after propensity score matching ( P = 0.07). The 1- and 2-year survival rates of discharged patients were 67% and 50% in the w/oCS group vs 60% and 45% in the CS group (log rank P = 0.29). Eighty-two patients answered the QOL questionnaire after a mean follow-up time of 4.2 ± 2.9 years. A total of 75% could handle their daily life; 57% were not limited in their usual activities. Mobility impairment was noted in 50%; 25% returned to work or school. There were no differences in the EuroQol 5-dimension indices between the patient groups. However, compared to a normative age-matched population, significantly lower indices were calculated.
Long-term survival rates in patients requiring extracorporeal life support are acceptable with a probable advantage for patients without an operation and a narrowed QOL. The results are promising and encouraging, but there is also a need for improvement.
关于体外生命支持患者的长期生存和生活质量（QOL）的数据较为缺乏。
通过电话访谈、使用欧洲五维健康量表（EuroQol 5-dimensions questionnaire）进行 QOL 分析，以及回顾性查询 2006 年至 2015 年期间雷根斯堡体外膜肺氧合（ECMO）登记数据库，评估预后数据。通过比较接受心脏手术干预（CS，189 例）和未接受心脏手术干预（w/oCS，307 例）的患者来进行统计分析。
w/oCS 组患者出院时的存活率高于 CS 组（w/oCS：41.7% vs CS：29.5%；P=0.004）。Kaplan-Meier 分析显示两组之间存在显著差异，w/oCS 组更有利（对数秩检验 P=0.02）。经过倾向评分匹配后，差异不再具有统计学意义（P=0.07）。出院患者的 1 年和 2 年存活率在 w/oCS 组分别为 67%和 50%，在 CS 组分别为 60%和 45%（对数秩检验 P=0.29）。在平均随访时间 4.2±2.9 年后，82 例患者回答了 QOL 问卷。共有 75%的患者能够自理日常生活；57%的患者日常活动不受限制。50%的患者存在行动障碍；25%的患者重返工作或学校。两组患者的欧洲五维健康量表指数无差异。然而，与年龄匹配的正常人群相比，计算得出的指数明显较低。
体外生命支持患者的长期生存率尚可，可能对未手术患者有利，生活质量有所下降。结果有一定的前景和鼓舞性，但仍有改进的空间。
