Gastrointestinal (GI) bleeding is a common complication in patients treated with venoarterial extracorporeal membrane oxygenation (VA ECMO), yet comprehensive data on its epidemiology, clinical correlates, and prognostic implications remain inadequately characterized. VA ECMO-treated patients at the Emergency Medicine Center of the First Affiliated Hospital with Nanjing Medical University from January 2017 to December 2023 (analysis cohort) and Intensive Care Unit of The First People's Hospital of Suqian from January 2022 to June 2024 (external validation cohort) were enrolled in this study. In the analysis cohort, stabilized inverse probability of treatment weighting (SIPTW) was used to balance baseline characteristics. Least absolute shrinkage and selection operator (LASSO) regression and binary logistic regression were used for variable selection and predictive model construction, respectively. The incidence of GI bleeding was 17.8

Artificial Liver Support System (ALSS) is a core therapeutic modality for liver failure, but hypotension is a common and severe complication during treatment, which may lead to treatment interruption and poor prognosis. This study aims to explore the independent risk factors of hypotension complicating ALSS treatment for liver failure, construct a predictive model, and provide evidence for clinical coping strategies. A retrospective cohort study was conducted. According to the occurrence of hypotension during treatment, they were divided into the hypotension group and the non-hypotension group. Clinical data of the two groups were collected and analyzed. 216 patients with liver failure who received ALSS treatment were included. Multivariate logistic regression analysis confirmed that age ≥ 65 years (OR = 2.379, 95

Objective:Early identification of ischemic stroke patients with large vessel occlusion can improve referral efficiency and shorten reperfusion time. The purpose of this study was to analyze the characteristics of patients with large vessel occlusion and identify factors that could predict large vessel occlusion.Methods:The clinical data of 432 patients with ischemic stroke treated through emergency green channel were retrospectively analyzed, and the differences between the large vessel occlusion group (LVO group) and the non-large vessel occlusion group (non-LVO group) were compared, and two independent risk factors of the LVO group were screened out by logistics regression analysis: baseline NIHSS score and D-dimer value. The predicted cutoff values of NIHSS score and D-dimer were further determined by the receiver operating characteristic (ROC) curve.Results:A total of 432 patients with ischemic stroke had complete imaging data, with a mean age of 68.5±12.4 years, including 275 (63.7%) males, and 245 (56.7%) in the LVO group and 187 (43.3%) in the non-LVO group. Age, hemorrhagic transformation, thrombolytic therapy, endovascular treatment, atrial fibrillation, baseline NIHSS score [14.0 (6.0-20.0) vs. 3.0 (1.0-6.0), P<0.05], and D-dimer value at admission [0.9(0.4-2.3) mg/L vs. 0.3 (0.2-0.5)mg/L, P<0.05] were statistically significant different between the two groups. Multivariate Logistic regression analysis showed that higher baseline NIHSS score( OR=1.22,95% CI: 1.17-1.27)and higher D-dimer value( OR=3.10,95% CI: 2.14-4.47)were independent risk factors for large vessel occlusion. Baseline NIHSS score combined with D-dimer value was a good predictor of large vessel occlusion(AUC 0.85 [0.81-0.89]). ROC curve suggested that NIHSS score >6.5 and D-dimer >0.57 mg/L were the cutoff values for predicting large vessel occlusion. Conclusions:Higher baseline NIHSS score and D-dimer value are valuable for early prediction of large vessel occlusion, patients with NIHSS score >6.5 points and D-dimer >0.57 mg/L should be promptly transported to an advanced stroke center for treatment.

OBJECTIVE:The objective of this study was to compare the safety and efficiency of different extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) connection methods. BACKGROUND:The number of patients receiving ECMO is increasing, and the fields of application are getting wider. However, patients receiving ECMO are prone to acute kidney injury and fluid overload requiring CRRT. There are few comparative studies of two different systems of connecting CRRT device and ECMO from safety and efficacy perspective. METHODS:This retrospective observational study included patients receiving ECMO in the extracorporeal life support centre of the First Affiliated Hospital of Nanjing Medical University from June, 2015, to December, 2020. Patients were divided into the parallel system group and integrated system group according to the connecting method between ECMO circuit and CRRT line. The outcomes were discharge survival rate, CRRT therapeutic dose completion rate, CRRT catheterisation time, CRRT initiating time, local bleeding at the CRRT catheter site, mean filter life, ECMO circuit thrombosis, ECMO air leakage, or blood leakage due to CRRT. RESULTS:Thirty patients in the parallel system group and 70 patients in the integrated system group were finally included. The discharge survival rate and CRRT therapeutic dose completion rate were not significantly different between the two groups. The parallel system group had significant longer CRRT initiating time (49.0 ± 12.1 min vs. 14.6 ± 2.1 min, P < 0.001) and shorter filter life (11.5 ± 3.2 h vs. 47.3 ± 14.0 h, P < 0.001) than the integrated system group. The occurrence rate of local bleeding was 93.3% in the parallel system group, and there is no bleeding case in the integrated system group. There was no case of ECMO circuit thrombosis from CRRT as well as ECMO air or blood leakage caused by CRRT in either group. ECMO therapy can be adapted by adjusting the position of the CRRT outlet in the integrated system. CONCLUSIONS:Connecting CRRT and ECMO as an integrated system might accelerate CRRT initiation, avoid local bleeding, and prolong filter life compared to the parallel system. The chance of developing CRRT-related ECMO circuit leak and thrombosis is manageable.

Background A protective or ultra-protective tidal volume strategy is widely applied to patients with acute respiratory distress syndrome (ARDS). The use of very low tidal volume has the potential to further redece ventilation-induced lung injury (VILI) comparde with a “normal” lung protective management. Plus, cardiogenic pulmonary edema (CPE) caused by hydrostatic mechanisms in patients with cardiogenic shock has similar respiratory mechanics to those found in patients with ARDS. And no consensus exists on mechanical ventilation parameter settings in patients with VA-ECMO. The study aimed to investigate the impact of an ultra-protective tidal volume strategy on the 28-day ventilator-free day (VFD) number in VA-ECMO–supported patients with refractory cardiogenic shock, including cardiac arrest. Methods The Ultra-ECMO trial is a randomized controlled, open-label, single-center prospective superiority trial. At the onset of ECMO initiation, we will divide patients randomly into an intervention group and a control group in a 1:1 ratio. The control group will adopt protective ventilation settings [initial tidal volume: 6 ml/kg of predicted body weight (PBW)] for ventilation, and the intervention group will adopt ultra-protective ventilation settings (initial tidal volume: 4 ml/kg of PBW) for ventilation. The procedure is expected to last 72 h, after which the ventilator settings will be at the intensivists' discretion. The primary outcome is the VFD number at 28 days after inclusion. The secondary outcomes will include respiratory mechanics; analgesic/sedation dosage; lung ultrasound score; interleukin-6, interleukin-8, and monocyte chemotactic protein-1 levels in broncho-alveolar lavage fluid at the moment of enrollment (T0), 24, 48, and 72 h (T1, T2, and T3, respectively) after ECMO initiation; total time (in days) required for ECMO weaning; length of stay in the intensive care unit; total cost of hospitalization; amounts of resuscitative fluids; and in-hospital mortality. Discussion VA-ECMO–treated patients without ARDS possess abnormal lung function. CPE, thoracic compliance reduction, and poor pulmonary blood perfusion are frequently present, and these patients can more easily progress to ARDS. It seems that targeting the protective tidal volume can lower adverse outcome incidence rates, even in patients without ARDS. This trial seeks to answer the question of whether adopting an ultra-protective tidal volume strategy can lead to superior primary and secondary outcomes compared to adopting a protective tidal volume strategy in patients treated by VA-ECMO. The Ultra-ECMO trial will provide an innovative mechanical ventilation strategy for VA-ECMO–supported patients for improving treatment outcomes at biological and potentially clinical levels. Clinical Trial Registration ChiCTR2200067118.

目的:研究急性心肌炎患者首次高敏肌钙蛋白T(high-sensitivity troponin T,hs-TnT)对其是否需要体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)支持的预测价值.方法:回顾性分析2017年1月一2020年7月在南京医科大学第一附属医院急诊就诊的98例急性心肌炎患者的临床资料,根据患者入院后是否需要ECMO支持分为ECMO支持组(ECMO组,32例)和非ECMO支持组(非ECMO组,66例),比较两组患者急诊首次hs-TnT、氨基末端脑利钠肽前体(N-terminal pro-B type natriuretic peptide,NT-proBNP)等指标的差异,以判断患者是否需要ECMO支持.结果:ECMO组hs-TnT值[3 580(1 656,8 935)ng/L]高于非 ECMO组[630(180,1496)ng/L,P＜0.001],ECMO组 NT-proBNP[10 577(3 701,24 164)pg/mL]高于非 ECMO组[565(240,3 736)pg/mL,P＜0.001].多因素 Logistic 回归分析显示:首次hs-TnT(OR=1.290,95％CI:1.024～1.626,P=0.031)、首次NT-proBNP(OR=1.081,95％CI:1.019～1.146,P=0.009)为急性心肌炎患者可能需行ECMO支持的相关危险因素.结论:急性心肌炎患者急诊首次hs-TnT值及NT-proBNP值可作为相关指标,用来预测患者是否需要ECMO支持.

目的 总结体外膜肺氧合辅助心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)对于成人院外心脏骤停(out-of-hospital cardiac arrest,OHCA)的经验和效果.方法 回顾南京医科大学第一附属医院急诊中心2015年4月至2022年4月40例成人OHCA-ECPR的资料,以出院存活/院内死亡、有/无旁观者复苏、有/无院际联动分组,比较年龄、性别、查尔森合并症指数、初始心律、无血流时间、心脏骤停至ECMO(extracorporeal membrane oxygenation)转流时间(CA-Pump On时间)、ECMO撤离成功率、存活率、ECMO时间、死亡时间、住院时间的差异.结果 ①40例OHCA-ECPR患者,出院存活9人(22.5％),其中7人(77.8％)神经功能预后良好.②存活组的无血流时间显著低于死亡组,且初始可电击心律的比例高.③旁观者复苏显著缩短无血流时间.④区域内OHCA-ECPR院际联动延长CA-Pump On时间,并不影响患者预后.结论 ECPR改善OHCA患者的预后,旁观者复苏缩短无血流时间,无血流时间短及初始可电击心律的OHCA患者ECPR的有效性显著.推荐区域内ECPR的院际联动,使更多的OHCA患者获益.

近年来体外膜氧合(extracporeal membrane oxygenation,ECMO)技术在危重症患者抢救中的应用越来越广泛[1-3],尤其新冠肺炎在世界范围内的流行进一步增加了人们对此项技术的认识,刺激了更多的医院开展体外膜氧合技术,俯卧位通气作为急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)治疗的一项重要手段在配合静脉静脉体外膜氧合(VV-ECMO)技术的使用中快速增长[4].

农药中毒是我国中毒和意外死亡的主要病因，随着百草枯的禁止销售和使用，敌草快（diquat, DQ）成为首选的联吡啶类除草剂。近年来DQ中毒病例持续增多，是目前中毒研究的热点 [1]。DQ中毒主要通过脂质过氧化反应产生氧自由基损伤细胞膜，导致细胞死亡，预后与摄入量存在明确相关性，对人的致死量为6~12 g（即浓度为20%的DQ溶液56.10~112.20 mL），尚无特效解毒剂 [2]。值得注意的是，肾脏既是DQ吸收后的主要排泄器官，也是DQ毒性损伤的主要靶器官 [2,3]。无论是多见的经消化道途径，还是本团队报道的经肌肉注射途径中毒病例 [4]，DQ中毒患者均易发生急性肾损伤。为了更好地了解DQ中毒致肾脏损伤的病理特点，既往研究仅有尸检病理报道 [5]，南京医科大学中毒研究所首次取得2例DQ中毒患者的肾活检病理（南京医科大学第一附属医院伦审号：2020-SR-099），总结相关临床资料和病理结果报道如下。

目的 本研究探讨早期乳酸判断体外心肺复苏患者预后的价值.方法:回顾收集本中心体外心肺复苏患者年龄,性别,病因,初始心律,预后,上机前或上机即刻血乳酸和pH.比较死亡与存活患者差异.结果 入选95例,平均年龄47岁,男性占69.5％;存活率29.5％.死亡患者与存活患者在年龄,性别比上差异无统计学意义,但死亡患者较存活患者可除颤心律占比更低(31.3％vs.60.8％)、乳酸水平更高[16.4(11.2,19.1)vs.9.2(3.2,15.0),mmol/L]、pH 更低[7.01(6.88,7.23)vs.7.37(7.10,7.43)],差异有统计学意义.多因素二元Logistic回归示可除颤心律(OR=0.295,95％CI:0.118～0.739),乳酸(OR=1.159,95％CI:1.068～1.258)和 pH 值(OR=0.017,95％CI:0.002～0.157)为预后不良的独立危险因素.以特异度100％为要求预判死亡,单乳酸截点为＞24 mmol/l;联合应用,截点为乳酸＞16 mmol/1且pH＜6.828.结论 可除颤心律,早期乳酸和pH值是体外心肺复苏患者预后的独立危险因素.早期乳酸＞24 mmol/l或者乳酸＞16 mmol/l且pH＜6.828为终止体外心肺复苏的一项指标.

目的 探讨Gensini评分联合中性粒细胞/淋巴细胞比值(NLR)对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后1年主要不良心血管事件(MACE)的预测价值.方法 STEMI患者60例均行PCI治疗,根据患者术后1年MACE发生情况分为MACE组(30例)和非MACE组(30例),比较两组相关临床指标,采用logistic逐步回归分析影响STEMI患者PCI术后1年MACE发生的预测因素.绘制ROC曲线评估相关指标独立或联合Gensini评分对STEMI患者PCI术后1年MACE发生的预测价值.结果 与非MACE组比较,MACE组高血压病史比例、淋巴细胞百分比及计数、单核细胞百分比和淋巴细胞/单核细胞比值均降低,而WBC、中性粒细胞百分比及计数、NLR和Gensini评分升高(P＜0.05).Gensini评分和NLR是STEMI患者PCI术后1年MACE的独立预测因素(P＜0.05)q Gensini评分联合NLR对STEMI患者PCI术后1年MACE的预测效能佳,灵敏度和特异度分别为0.90和0.97.结论 Gensini评分和NLR是STEMI患者术后1年MACE的独立预测因素,二者联合检测可获得更高预测效能.

目的:总结连续性肾替代治疗(continuous renal replacement therapy,CRRT)在体外膜氧合(extracorporeal embrane oxygenation,ECMO)病人中的临床经验.方法:搜集124例ECMO支持超过24 h的病人资料,根据是否联合CRRT分为CRRT+ECMO组(n=74)及ECMO组(n=50),根据CRRT时长分为CRRT<7 d组(n=30)及CRRT≥7 d组(n=44);心脏骤停病人52例根据是否联合CRRT分为CRRT+ECMO组(n=38)及ECMO组(n=14);心脏骤停病人中根据CRRT时长分为CRRT<7 d组(n=17)及CRRT≥7 d组(n=21).分别分析各组病人的ECMO辅助时间、有创机械通气时间、住院时间以及出院存活率.结果:124例成年病人中CRRT+ECMO组较单纯ECMO组ECMO辅助时间、有创机械通气时间更长,出院存活率更低(P<0.05～P<0.01),而住院时间差异无统计学意义(P>0.05);CRRT<7 d组较CRRT≥7 d组ECMO辅助时间、有创机械通气时间以及住院时间更短,出院存活率更低,差异有统计学意义(P<0.05～P<0.01);心脏骤停病人中CRRT+ECMO组较单纯ECMO组ECMO辅助时间、有创机械通气时间及住院时间差异无统计学意义(P>0.05),而出院存活率更低(P<0.01);心脏骤停病人中CRRT<7 d组较CRRT≥7 d组ECMO辅助时间、有创机械通气时间以及住院时间更短(P<0.01),出院存活率差异无统计学意义(P>0.05).结论:ECMO支持同时需要CRRT治疗的病人有着更低的出院存活率,可能与其肾损伤更严重有关;对于需要CRRT支持的多数病人而言CRRT支持≥7 d的病人出院存活率较高,而出现心脏骤停的病人CRRT时长与病人存活率无明确关系,需要更大样本研究证实.

目的 探讨血小板动态变化对体外膜肺氧合(ECMO)支持下患者28 d预后的预测价值.方法 回顾2017年1月至2020年12月来自南京医科大学第一附属医院急诊医学中心使用ECMO进行生命支持的60例患者.收集患者的基线资料,上机第1～7天血小板最低值,计算血小板变化值及变化率,根据ECMO上机后28 d生存状态分为存活组与死亡组,以血小板变化值及血小板变化率绘制受试者工作曲线(ROC),评估其对预后的预测价值.结果 在接受VV-ECMO患者中,以第7天的血小板变化值及变化率对患者28 d结局预测效果最佳(AUCΔPLT-7=0.772,P=0.016;AUCΔPLT7％=0.764,P=0.020),当血小板变化值以4×109/L为临界值时,敏感度为0.857,特异度为0.615,当血小板变化率以-28.99％为临界值时,敏感度为0.643,特异度为0.846;在接受VA-ECMO患者中,以第6天的血小板变化率对患者28 d结局预测效果最佳(AUCΔPLT6％=0.707,P=0.045),当血小板变化率以-26.19％为临界值时,敏感度为0.842,特异度为0.643.结论 血小板动态变化与接受ECMO患者的28 d预后具有相关性,结合血小板变化值和变化率的临界值更能预测两种ECMO模式下患者的不良预后.

Background: Mortality of patients suffering from critical illness has been dramatically improved with advanced technological development of extracorporeal membrane oxygenation (ECMO) therapy. However, the majority of ECMO-supported patients failed to wean from ECMO therapy. As one of several options, cardiopulmonary rehabilitation serves as effective intervention in the improvement of cardiovascular and respiratory function in various major critical illness. Nonetheless, its role in facilitating ECMO weaning has not yet been explored. The purpose of this study is to investigate the effectiveness of cardiopulmonary rehabilitation on rate of ready for ECMO weaning in ECMO-supported patients (CaRe-ECMO). Methods: The CaRe-ECMO trial is a randomized controlled, parallel group, clinical trial. This trial will be performed in a minimum number of 366 ECMO-supported eligible patients. Patients will be randomly assigned to either: (1) the CaRe-ECMO group, which will be treated with usual care including pharmacotherapy, non-pharmacotherapy, and specific nursing for ECMO therapy and the CaRe-ECMO program; or (2) the control group, which will receive usual care only. The CaRe-ECMO program consists of protocolized positioning, passive range of motion (PROM) training, neuromuscular electrical stimulation (NMES), surface electrical phrenic nerve stimulation (SEPNS), and pulmonary rehabilitation. The primary outcome of the CaRe-ECMO trial is the rate of ready for ECMO weaning at CaRe-ECMO day 7 (refers to 7 days after the CaRe-ECMO program initiation). Secondary outcomes include rate of ECMO and mechanical ventilation weaning, total length in day of ready for ECMO weaning, ECMO weaning and mechanical ventilation, all-cause mortality, rate of major post-ECMO complications, ECMO unit length of stay (LOS) and hospital LOS, total cost for hospitalization, cerebral performance category (CPC), activities of daily living (ADL), and health-related quality of life (HRQoL). Discussion: The CaRe-ECMO is designed to answer the question “whether cardiopulmonary rehabilitation can facilitate weaning of ECMO (CaRe-ECMO).” Should the implementation of the CaRe-ECMO program result in superior primary and secondary outcomes as compared to the controls, specifically the add-on effects of cardiopulmonary rehabilitation to the routine ECMO practice for facilitating successful weaning, the CaRe-ECMO trial will offer an innovative treatment option for ECMO-supported patients and meaningfully impact on the standard care in ECMO therapy. Clinical Trial Registration: ClinicalTrials.gov , identifier: NCT05035797.

目的 分析较低的抗凝强度能否减少体外膜氧合(ECMO)患者并发症的发生.方法 搜集2015年03月至2021年03月江苏省人民医院体外生命支持中心88例非心脏外科术后的疾病本身无需抗凝的ECMO支持超过72 h的患者临床资料,根据ECMO运行第3天的平均活化部分凝血活酶时间(APTT)水平分为APTT＜50 s组(n=53)及APTT≥50 s组(n=35);静脉静脉 ECMO(VV-ECMO)亚组中分为 APTT＜50 s(n=23)组及 APTT≥50 s 组(n=10);静脉动脉ECMO(VA-ECMO)亚组中分为APTT＜50 s组(n=30)及APTT≥50 s组(n=25).分别比较两组患者的ECMO运行期间红细胞日均输注量、出血发生率、血栓发生率和全因病死率.结果 88例患者中APTT＜50 s组较APTT≥50 s组血栓发生率及全因病死率差异无统计学意义(P＞0.05),而出血发生率降低(7.5％vs.35.7％)及红细胞日均输注量明显减少(0.50 U vs.0.88 U)(P＜0.05);33例 VV-ECMO患者中APTT＜50 s组较APTT≥50 s组全因病死率、出血发生率降低,红细胞日均输注量减少,血栓发生率升高,但两组间差异无统计学意义(P＞0.05);55例VA-ECMO患者中全因病死率、出血、血栓发生率及红细胞日均输注量两组间差异无统计学意义(P＞0.05).结论 疾病本身无需抗凝的患者较低的抗凝强度减少了 ECMO患者出血并发症的发生,此类患者较低的抗凝强度是合理的,更大样本量的研究有待于开展.

目的 探讨在体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)上机初期,红细胞分布宽度(red blood cell volume distribution width,RDW)和血小板分布宽度(platelet distribution width,PDW)对急性心肌梗死患者预后的判断价值.方法 回顾性分析2017年4月至2021年7月期间接受静脉-动脉体外膜肺氧合(veno-arterial extracorporeal membrane oxygenation,VA-ECMO)治疗的急性心肌梗死患者.比较不同预后患者一般情况、ECMO上机前APACHEⅡ评分、治疗期间最高的氨基末端脑钠尿肽前体(N-terminal fragment of the brain natriuretic peptide precursor,NT-proBNP)和肌钙蛋白T数值.ECMO运行后即刻监测的血红蛋白、RDW、血小板计数、PDW和平均血小板体积.并记录同时期采血检测的活化部分凝血酶原时间.比较不同预后组上述指标的差异,并采用Logistic回归分析与预后的相关性.结果 入选55例,存活18例(32.8％),平均年龄(54.7±11.2)岁,其中男性48例(87.3％).存活组上机前前APACHEⅡ评分低于死亡组(分:26.00±6.54 vs.30.54±4.35,P<0.05).存活组RDW低于死亡组(％:12.57±0.60 vs.128.59±0.80);PDW在两组间差异无统计学意义(P>0.05).Logistic回归分析显示,上机前APACHEⅡ评分与患者预后相关,而RDW与患者预后不相关.结论 VA-ECMO支持的急性心肌梗死患者上机前APACHEⅡ评分可以预测患者预后,而RDW和PDW不适合作为患者预后判断指标.

目的 探讨早期全身计算机断层扫描(whole-body computed tomography,WBCT)联合冠状动脉造影(coronary angiography,CAG)检查在体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)患者中的安全性,及在心脏骤停(cardiac arrest,CA)病因诊断、心肺复苏(cardiopulmonary resuscitation,CPR)并发症等方面的应用价值.方法 回顾性收集2017年1月至2021年7月间于南京医科大学第一附属医院急诊科行ECPR的患者,排除标准包括年龄不满18岁及临床资料不全患者,收集ECPR后WBCT及CAG检查结果.结果 共89例ECPR患者纳入研究,年龄为(47±17)岁,均行WBCT检查,未发生ECMO及气管插管管路脱落等不良事件.WBCT在病因诊断方面共发现7例肺栓塞、3例主动脉夹层、2例脑出血.WBCT发现42例CPR并发症,包括20例发生肋骨骨折、5例气胸、5例纵膈积气、6例皮下气肿和6例穿刺部位血肿或肿胀.55例行CAG检查,发现7例左主干病变、32例左前降支病变、15例回旋支病变和12例右冠状动脉病变.结论 早期WBCT和CAG检查在ECPR患者的病因诊断、CPR并发症、指导治疗方面具有重要意义且安全可行.

目的 分析急性冠脉综合征(acute coronary syndrome,ACS)导致的心源性休克患者使用静脉-动脉体外膜氧合(veno-arterial extracorporeal membrane oxygenation,VA-ECMO)治疗早期容量平衡与预后的相关性.方法 本研究回顾自2015年3月至2020年11月接受VA-ECMO治疗的患者,筛选出VA-ECMO运行>3 d并以ACS为病因的心源性休克患者.比较ACS患者与非ACS患者一般情况、联合连续肾脏替代治疗(continuous renal replacement therapy,CRRT)、主动脉内球囊反搏(intra-aortic balloon pump,IABP)及有创机械通气情况.统计ACS患者预后与前3 d每天容量平衡及总平衡的相关性.根据ACS患者的前3 d总容量的正负平衡分组,比较患者一般情况、肾功能指标及联合CRRT、IABP、有创机械通气的情况.结果 入选32例患者.ACS患者与非ACS患者在年龄、性别比例、是否联合IABP治疗方面比较差异有统计学意义(P<0.05).ACS患者根据前3 d每日容量平衡正负分组,正负两组存活率比较差异无统计学意义(P>0.05);根据前3 d总容量平衡结果进行分组,两组存活率比较差异有统计学意义(20.0％vs.58.8％,P<0.05),但两组年龄、性别比、VA-ECMO运转时间、肾功能变化比较差异无统计学意义(P>0.05),联合CRRT、IABP或有创通气等差异无统计学意义(P>0.05).结论 对于ACS导致的心源性休克患者,接受VA-ECMO支持治疗3 d以上时,前3 d总容量平衡呈负平衡的患者较正平衡患者存活概率更高.

Objective: To study the correlation between the mean arterial pressure (MAP) level in the first 6 hours of extracorporeal cardiopulmonary resuscitation (ECPR) and patients’ neurological outcomes. Methods: Sex, age, basic comorbidities, the time from the first cardiac arrest to the start of CPR, the time from the first cardiac arrest to extracorporeal membrane oxygenation (ECMO), standardized ECMO flow, and the pH value at the beginning of ECMO and after 6 hours were recorded. MAP was recorded every 2 hours during the first 6 hours, and the average was calculated. The lactic acid clearance rate of the first 6 hours was calculated. Evaluated the neurological prognosis of patients at discharge. Then the patients were divided into groups according to their average MAP, and the above variables were compared in groups. Results: Enrolled 63 adult ECPR patients. There were no statistically significant differences in sex, age, basic comorbidities, the time from the first cardiac arrest to the start of conventional CPR, the time from the first cardiac arrest to the start of ECMO, standardized ECMO flow, 6-hour lactic acid clearance rate, pH value at the sixth hour of operation between two groups. The pH value at the start of ECMO, survival rate, and good prognosis rate in low average MAP group were significantly lower. Low average MAP was associated with poor neurological outcomes (relative risk (RR) 1.50, 95% CI 1.17, 1.92). The RR of good neurological outcome for patients with average MAP ⩾65 mmHg was 5.91 (95% CI 1.45, 24.06), and the RR for average MAP ⩾100 mmHg was 1.18 (95% CI 0.19, 7.52). Conclusion: For ECPR patients, average MAP <65 mmHg in the first 6 hours of ECPR indicates a poor neurological prognosis. However, whether higher average MAP levels can improve the neurological prognosis of ECPR patient remains to be further studied.