Zhou Y H, Zhao X, Guo Y Y, Yang J M, Dai D P, Rui Z A, Du Y, Pang S, Miao G R, Wang X F, Zhao X Y, Dong J Z
Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2022 Mar 24;50(3):270-276. doi: 10.3760/cma.j.cn112148-20210512-00419.
To evaluate the efficacy within the first 24 h post extracorporeal membrane pulmonary oxygenation (ECMO) and the impact of early efficacy on the prognosis of adult patients with fulminant myocarditis (FM). This retrospective case analysis study included hospitalized patients (age≥18 years) who were diagnosed with fulminant myocarditis from November 2016 to May 2021 in the First Affiliated Hospital of Zhengzhou University. Patients were divided into survival or non-survival groups according to treatment outcomes. The age, sex, treatments, drug use, ECMO use, clinical and laboratory data (before and 24 h after the use of ECMO) were analyzed. The change rate of clinical and laboratory data after 24 h use of ECMO was calculated to find differences between two groups. Multivariate logistic regression was used to analyze the related factors with in-hospital death and complication between the two groups. A total of 38 FM patients treated with ECMO were included. There were 23 cases (60.5%) in the survival group, aged (39.6±13.7) years, and 17 (73.9%) cases were female. The total ECMO time was (134.4±71.3)h. There were 15 cases (39.5%) in non-survival group, aged (40.0±15.8) years, and there were 12(80.0%) female, the ECMO time was (120.1±72.4) h in this group. The proportion of tracheal intubation and continuous renal replacement therapy in the survivor group and dosage of norepinephrine within 24 h after ECMO implantation were significantly less than in non-survival group (all <0.05). There was no significant difference in all efficacy related biochemical indexes between two groups before ECMO use. The levels of lactic acid, procalcitonin, creatinine, alanine aminotransferase, aspartate aminotransferase, creatine kinase-MB, cardiac troponin I and N-terminal B-type natriuretic peptide prosoma were significantly less in survival group than in non-survival group at 24 h after the use of ECMO (all <0.05). Results of multivariate logistic regression analysis showed that the higher 24 h change rate of creatinine (=0.587, 95% 0.349-0.986, =0.044) and creatine kinase-MB (=0.177, 95% 0.037-0.841, =0.029) were positively correlated with reduced risk of in-hospital mortality. The central hemorrhage and acute kidney injury in survival group were less than in non-survivor group (<0.05). After 24 h early use of ECMO in FM patients, the improvement of various efficacy related biochemical test indexes in the survival group was better than that in the non-survival group. Faster reduction of creatine kinase-MB and creatinine values within 24 h ECMO use is positively correlated with reduced risk of in-hospital mortality in adult patients with FM.
评估体外膜肺氧合（ECMO）治疗后24小时内的疗效以及早期疗效对暴发性心肌炎（FM）成年患者预后的影响。本回顾性病例分析研究纳入了2016年11月至2021年5月在郑州大学第一附属医院住院的年龄≥18岁、诊断为暴发性心肌炎的患者。根据治疗结果将患者分为存活组和非存活组。分析患者的年龄、性别、治疗方法、用药情况、ECMO使用情况、临床及实验室数据（ECMO使用前和使用后24小时）。计算ECMO使用24小时后临床及实验室数据的变化率，以发现两组之间的差异。采用多因素logistic回归分析两组患者院内死亡及并发症的相关因素。共纳入38例接受ECMO治疗的FM患者。存活组23例（60.5%），年龄（39.6±13.7）岁，女性17例（73.9%）。ECMO总时长为（134.4±71.3）小时。非存活组15例（39.5%），年龄（40.0±15.8）岁，女性12例（80.0%），该组ECMO时长为（120.1±72.4）小时。存活组气管插管及持续肾脏替代治疗的比例以及ECMO植入后24小时内去甲肾上腺素的用量均显著低于非存活组（均<0.05）。ECMO使用前两组所有疗效相关生化指标均无显著差异。ECMO使用后24小时，存活组乳酸、降钙素原、肌酐、谷丙转氨酶、谷草转氨酶、肌酸激酶同工酶、心肌肌钙蛋白I及N末端B型利钠肽原水平均显著低于非存活组（均<0.05）。多因素logistic回归分析结果显示，肌酐24小时变化率较高（=0.587，95%可信区间0.349 - 0.986，=0.044）和肌酸激酶同工酶（=0.177，95%可信区间0.037 - 0.841，=0.029）与降低院内死亡风险呈正相关。存活组中枢出血和急性肾损伤少于非存活组（<0.05）。FM患者早期使用ECMO 24小时后，存活组各项疗效相关生化检测指标的改善情况优于非存活组。ECMO使用24小时内肌酸激酶同工酶和肌酐值更快下降与FM成年患者降低院内死亡风险呈正相关。
