体外膜肺氧合治疗急性呼吸窘迫综合征幸存者的生活质量和肺功能。

Quality of Life and Lung Function in Survivors of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome.

机构信息

From the Department of Anesthesia, Critical Care, and Emergency, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda - Ospedale Maggiore Policlinico, Milan (MI), Italy (G.G., V.S., D.T., R.R., A.P.) Department of Pathophysiology and Transplantation, University of Milan, Milan (MI), Italy (G.G., F.C., F.B., L.C.M., E.S., A.P.) Department of Preventive Medicine, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda - Ospedale Maggiore Policlinico, Milan (MI), Italy (L.P.) Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany (L.G.) Department of Health Sciences, University of Milan, Milan (MI), Italy (D.C.).

出版信息

Anesthesiology. 2019 Apr;130(4):572-580. doi: 10.1097/ALN.0000000000002624.

DOI:10.1097/ALN.0000000000002624

PMID:30875355

Abstract

BACKGROUND

Survivors of acute respiratory distress syndrome (ARDS) have long-term impairment of pulmonary function and health-related quality of life, but little is known of outcomes of ARDS survivors treated with extracorporeal membrane oxygenation. The aim of this study was to compare long-term outcomes of ARDS patients treated with or without extracorporeal membrane oxygenation.

METHODS

A prospective, observational study of adults with ARDS (January 2013 to December 2015) was conducted at a single center. One year after discharge, survivors underwent pulmonary function tests, computed tomography of the chest, and health-related quality-of-life questionnaires.

RESULTS

Eighty-four patients (34 extracorporeal membrane oxygenation, 50 non-extracorporeal membrane oxygenation) were studied; both groups had similar characteristics at baseline, but comorbidity was more common in non-extracorporeal membrane oxygenation (23 of 50 vs. 4 of 34, 46% vs. 12%, P < 0.001), and severity of hypoxemia was greater in extracorporeal membrane oxygenation (median PaO2/FIO2 72 [interquartile range, 50 to 103] vs. 114 [87 to 133] mm Hg, P < 0.001) and respiratory compliance worse. At 1 yr, survival was similar (22/33 vs. 28/47, 66% vs. 59%; P = 0.52), and pulmonary function and computed tomography were almost normal in both groups. Non-extracorporeal membrane oxygenation patients had lower health-related quality-of-life scores and higher rates of posttraumatic stress disorder.

CONCLUSIONS

Despite more severe respiratory failure at admission, 1-yr survival of extracorporeal membrane oxygenation patients was not different from that of non-extracorporeal membrane oxygenation patients; each group had almost full recovery of lung function, but non-extracorporeal membrane oxygenation patients had greater impairment of health-related quality of life.

摘要

背景

急性呼吸窘迫综合征（ARDS）幸存者的肺功能和健康相关生活质量长期受损，但接受体外膜氧合治疗的 ARDS 幸存者的结局知之甚少。本研究旨在比较接受和不接受体外膜氧合治疗的 ARDS 患者的长期结局。

方法

在一家单中心进行了一项前瞻性、观察性研究，纳入了 2013 年 1 月至 2015 年 12 月期间的成人 ARDS 患者。出院后 1 年，幸存者接受了肺功能测试、胸部计算机断层扫描和健康相关生活质量问卷调查。

结果

共纳入 84 例患者（34 例接受体外膜氧合治疗，50 例未接受体外膜氧合治疗）；两组患者在基线时具有相似的特征，但非体外膜氧合组的合并症更常见（23/50 比 4/34，46%比 12%，P<0.001），且体外膜氧合组的低氧血症严重程度更重（中位 PaO2/FIO2 72[四分位间距，50~~103]比 114[87~~133]mmHg，P<0.001），呼吸顺应性更差。1 年时，生存率相似（22/33 比 28/47，66%比 59%；P=0.52），两组的肺功能和计算机断层扫描均基本正常。非体外膜氧合组的健康相关生活质量评分较低，创伤后应激障碍发生率较高。