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混合性休克、心源性休克和感染性休克行静脉-动脉体外膜肺氧合治疗的预后。

Prognosis of Venoarterial Extracorporeal Membrane Oxygenation in Mixed, Cardiogenic and Septic Shock.

机构信息

From the Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

出版信息

ASAIO J. 2023 Jul 1;69(7):658-664. doi: 10.1097/MAT.0000000000001933. Epub 2023 Apr 4.

Abstract

Mixed cardiogenic-septic shock (MS), defined as the combination of cardiogenic (CS) and septic (SS) shock, is often encountered in cardiac intensive care units. Herein, the authors compared the impact of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in MS, CS, and SS. Of 1,023 patients who received VA-ECMO from January 2012 to February 2020 at a single center, 211 with pulmonary embolism, hypovolemic shock, aortic dissection, and unknown causes of shock were excluded. The remaining 812 patients were grouped based on the cause of shock at VA-ECMO application: i) MS (n = 246, 30.3%), ii) CS (n = 466, 57.4%), iii) SS (n = 100, 12.3%). The MS group was younger and had lower left ventricular ejection fraction than the CS or SS group did. The 30 day and 1 year mortalities were the highest in SS (30 day mortality: 50.4% vs. 43.3% vs. 69.0%, p < 0.001 for MS versus CS versus SS, respectively; 1 year mortality: 67.5% vs. 53.2% vs. 81.0%, p < 0.001 for MS versus CS versus SS, respectively). Posthoc analysis showed that the 30 day mortality of MS was not different from CS, while the 1 year mortality of MS was worse than CS but better than SS. Venoarterial extracorporeal membrane oxygenation application for MS may help improve survival and should therefore be considered if indicated.

摘要

混合心源性-感染性休克(MS)定义为心源性(CS)和感染性(SS)休克的组合,在心脏重症监护病房中经常遇到。在此,作者比较了静脉-动脉体外膜肺氧合(VA-ECMO)在心源性-感染性休克、心源性休克和感染性休克中的作用。在一个中心,从 2012 年 1 月至 2020 年 2 月期间,有 1023 名患者接受了 VA-ECMO,其中 211 名患者患有肺栓塞、低血容量性休克、主动脉夹层和原因不明的休克被排除在外。剩余的 812 名患者根据 VA-ECMO 应用时的休克原因进行分组:i)MS(n=246,30.3%),ii)CS(n=466,57.4%),iii)SS(n=100,12.3%)。MS 组患者较年轻,左心室射血分数较 CS 或 SS 组低。SS 组的 30 天和 1 年死亡率最高(30 天死亡率:50.4%比 43.3%比 69.0%,p<0.001 用于 MS 与 CS 与 SS 相比,分别;1 年死亡率:67.5%比 53.2%比 81.0%,p<0.001 用于 MS 与 CS 与 SS 相比,分别)。事后分析显示,MS 的 30 天死亡率与 CS 无差异,而 MS 的 1 年死亡率虽劣于 CS,但优于 SS。MS 患者应用静脉-动脉体外膜肺氧合可能有助于提高生存率,因此如果有指征,应考虑应用。

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