Objective:To systematically evaluate the effect of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) combined with intra-aortic balloon pumping (IABP) on the mortality of patients with cardiogenic diseases.Methods:Systematic searches were conducted in PubMed, the Cochrane Library, Embase, Web of Science, Wanfang data, CNKI and CBM to collect articles about using VA-ECMO combined with IABP to treat patients with cardiogenic diseases published up to April 2022. Two reviewers independently screened articles, extracted data and evaluated quality, and then the meta-analysis was performed using Stata 17 software.Results:A total of 15 528 patients were enrolled in 84 studies, of which 8 520 patients received VA-ECMO combined with IABP (experimental group) and 7 008 patients only received VA-ECMO (control group). Meta-analysis showed that as compared with the control group, the 30-d mortality/inpatient mortality [relative risk (RR) = 0.86, 95% confidence interval (CI) (0.83, 0.89), Z = 8.64, P < 0.000 01] and the incidence of neurological complications [RR = 0.70, 95%CI (0.54, 0.90), Z = 2.78, P = 0.005] decreased remarkably, and the success rate of weaning from ECMO [RR = 1.35, 95%CI (1.28, 1.42), Z = 11.89, P < 0.000 01] increased obviously in the experimental group. Subgroup analysis showed that the 30-d mortality/inpatient mortality in patients with heart-related mixed diseases [RR = 0.85, 95%CI (0.81, 0.90), Z = 5.99, P < 0.000 01] and in patients with acute coronary syndrome (ACS) [RR = 0.68, 95%CI (0.63, 0.74), Z = 9.21, P < 0.000 01] and the incidence of mixed neurological complications [RR = 0.58, 95%CI (0.40, 0.84), Z = 2.90, P = 0.004] were much lower, and the success rate of weaning from ECMO in patients with postcardiotomy [RR = 1.22, 95%CI (1.10, 1.34), Z = 3.88, P = 0.000 1] and heart-related mixed diseases [RR = 1.45, 95%CI (1.37, 1.53), Z = 12.51, P < 0.000 01] were much higher in the experimental group than those in the control group.Conclusion:Compared with VA-ECMO alone, VA-ECMO combined with IABP can reduce 30-d mortality/inpatient mortality in patients with heart-related mixed diseases and ACS, increase the success rate of weaning from ECMO in patients with postcardiotomy and heart-related mixed diseases, and reduce mixed neurological complications.

Objective To evaluate the prognostic value of improved national early warning score（INEWS） in critically ill patients.Methods The 24 h basic vital signs,related biochemical indexes and state of consciousness of 733 patients admitted to the Pulmonary and Critical Care Department of The First Affiliated Hospital of Xi’an Medical College from January 2016 to December 2019 were collected for INEWS scoring,acute physiology and chronic health evaluation score（APACHEⅡ score） and British national early warning score（NEWS score）.According to the discharge outcome,the patients were assigned into survival group and death group.The differences in related indexes and scores between the two groups were compared to study the relationship between score and mortality,the receiver operating characteristic curve（ROC curve） was drawn to compare the area under ROC curve（AUC） and cutoff value（Cut-off value）,and the survival curves of INEWS score of the two groups were compared to predict mortality.Results In total,733 patients were enrolled in the study,including 468 males,265 females,572 in the survival group and 161 in the death group,with survival rate of 78.04% and mortality rate of 21.96%.The INEWS,APACHEⅡ,and NEWS scores in the death group were 18（14,25）,10（7,12）,11（8,13）,respectively,all higher than those in the survival group [11（1,16）,7（5.25,9）,8（6,10）];the differences were statistically significant（P＜0.05）.The AUCs and 95% CIs of INEWS,APACHEⅡ and NEWS were 0.74,0.76,0.70,and（0.69,0.78）,（0.72,0.81）,（0.65,0.75）,respectively.The Youden index of INEWS was 10.5 points with a specificity of 85.3%,and a sensitivity of 50.3%.Survival analysis results showed that when Youden index ≥ 10.5 points,about the hospitalized mortality rate of ICU patients was much higher than that of the patients with INEWS ＜10.5 points;the difference was statistically significant（P＜0.001）.Conclusion The INEWS can be used to predict the prognosis in critically ill patients.Score of 10.5 or higher indicates high mortality,thus INEWS can provide more convenient prognostic evaluation indicators of ICU patients for medical workers.

Objective:To explore whether SpO2/FiO2 can be used as a reliable noninvasive testing indicators for predicting clinical outcome in patients with ARDS.Methods:This was a retrospective study of 221 ARDS patients enrolled in the Department of Respiratory Critical Care of our hospital from January 2016 to December 2019. SpO2, PaO2, pH, FiO2 and APACHE Ⅱ score within 24 hours of admission were collected. The relationship between SpO2/FiO2 and PaO2/FiO2 was analyzed by using linear regression methods. Receiver operator characteristic curve (ROC) were plotted to compare the area under the SpO2/FiO2, PaO2/FiO2 and APACHE Ⅱ score ROC curves (AUC).Results:PaO2/FiO2 and SpO2/FiO2 were highly correlated (R2=0.641, P＜0.001), AUC of PaO2/FiO2, SpO2/FiO2, APACHE Ⅱ score that predicted hospital mortality in patients with ARDS was 0.586 (95%CI: 0.498-0.674, P=0.051), 0.644 (95%CI: 0.503-0.681, P＜0.05), 0.782 (95%CI: 0.717-0.846, P＜0.05), respectively.Conclusion:SpO2/FiO2 can be a substitute for PaO2/FiO2 as a reliable noninvasive indicator for predicting clinical outcome in ARDS patients.

The dynamic changes of pulmonary ventilation and gas exchange were common in pulmonary pathophysiology.Although related detection methods as chest X-ray, CT, magnetic resonance imaging (MRI) had certain effect in the evaluation and treatment of pulmonary diseases, which can′t still fully assess the function of pulmonary ventilation, pulmonary interstitial oxygen absorption, gas exchange, etc., especially having certain limitations in the diagnosis for local lesions.However, hyperpolarized 129Xe MRI uniquely images technology characterised by non-invasiveness and no ionizing radiation.Meanwhile, It has not only a unique application role for chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, ect., but also a good practical value for expressing pulmonary ventilation, evaluating airway microstructure, exploring gas exchange, and assessing local pulmonary lesion.This article reviews the application of hyperpolarized 129Xe MRI uniquely images in pulmonary diseases.

体外膜肺氧合(ECMO)技术目前在临床中应用的越来越广泛，为严重心肺功能衰竭等重症患者带来了生存的希望。但ECMO治疗过程中存在各种并发症，其中出血这类凝血功能障碍问题严重影响ECMO治疗后患者的预后。近年来，凝血相关指标与ECMO治疗出血风险之间的关系成为研究热点，深入探讨凝血相关指标与ECMO治疗出血风险之间的关系，可帮助指导临床决策，减少出血相关并发症的发生，改善患者的预后。