Stoll C, Haller M, Briegel J, Meier M, Manert W, Hummel T, Heyduck M, Lenhart A, Polasek J, Bullinger M, Schelling G
Institut für Anaesthesiologie, Ludwig-Maximilians-Universität, München.
Anaesthesist. 1998 Jan;47(1):24-9. doi: 10.1007/s001010050518.
Treatment of severe acute respiratory distress syndrome (ARDS) with extracorporeal membrane oxygenation (ECMO) can be lifesaving but requires maximal use of intensive care resources over prolonged periods of time, resulting in high costs. Little is known about the health-related quality of life (HRQL) in long-term survivors. This case-controlled retrospective study was designed to assess the health-related quality of life in long-term survivors of ARDS and ECMO-therapy.
14 long-term survivors of ARDS (APACHE II score = 24, Lung Injury Score = 3.25, median values) treated using ECMO between 1992 and 1995 (median time interval between data collection and discharge from the ICU 16 months) and 14 ARDS-patients conventionally treated during the same period (group I) were identified and completed the SF-36 Health Status Questionnaire (Medical Outcome Trust, Boston, USA). 14 healthy subjects (group II) were drawn at random from a large data base generated to provide normal values for the SF-36 in a German population. All three groups were comparable with respect to sex and age.
Long-term survivors of ECMO-therapy reported significant reductions in physical functioning when compared with patients treated by mechanical ventilation alone (group I, -12.5%, p < 0.05) and with healthy controls (group II, -50%, p < 0.05) and showed a higher incidence of chronic physical pain (+5% and +24%, respectively, p < 0.05). There were no differences with regard to the mental health dimensions of the SF-36 (e.g. vitality, mental health index or social functioning) between ECMO-patients and all controls. Nine patients (64.3%) from the ECMO group versus all patients treated conventionally (group I) had full-time employment (p = 0.46, Chi2 test).
The majority of long-term survivors of ECMO-treatment show good physical and social functioning, including a high rate of employment. The more aggressive approach of ECMO-therapy and a possibly more severe underlying disease process may explain impairments in health-related quality of life outcomes after ECMO-treatment. Despite these limitations, long-term survivors of ECMO-therapy are able to reach a highly satisfactory health-related quality of life.
采用体外膜肺氧合（ECMO）治疗严重急性呼吸窘迫综合征（ARDS）可挽救生命，但需要在较长时间内最大限度地利用重症监护资源，导致成本高昂。对于长期存活者与健康相关的生活质量（HRQL）了解甚少。本病例对照回顾性研究旨在评估ARDS和ECMO治疗的长期存活者与健康相关的生活质量。
确定1992年至1995年间使用ECMO治疗的14例ARDS长期存活者（急性生理与慢性健康状况评分系统II [APACHE II]评分为24，肺损伤评分为3.25，均为中位数）（数据收集与重症监护病房出院之间的中位时间间隔为16个月），以及同期接受传统治疗的14例ARDS患者（第一组），并完成了SF - 36健康状况调查问卷（美国波士顿医疗结局信托）。从一个为提供德国人群SF - 36正常值而建立的大型数据库中随机抽取14名健康受试者（第二组）。所有三组在性别和年龄方面具有可比性。
与仅接受机械通气治疗的患者（第一组，降低12.5%，p < 0.05）和健康对照组（第二组，降低50%，p < 0.05）相比，ECMO治疗的长期存活者报告身体功能显著下降，且慢性身体疼痛发生率更高（分别增加5%和24%，p < 0.05）。ECMO患者与所有对照组在SF - 36的心理健康维度（如活力、心理健康指数或社会功能）方面没有差异。ECMO组的9例患者（64.3%）与所有接受传统治疗的患者（第一组）均有全职工作（p = 0.46，卡方检验）。
ECMO治疗的大多数长期存活者表现出良好的身体和社会功能，包括高就业率。ECMO治疗更积极的方法以及可能更严重的潜在疾病过程可能解释了ECMO治疗后与健康相关的生活质量结果受损的原因。尽管存在这些限制，ECMO治疗的长期存活者能够达到高度令人满意的与健康相关的生活质量。
