在静脉外体膜氧化器支期间的酸状态在心脏性休克患者中
Garima Dahiya1, J Kyle Bohman2, Joseph E Tonna3
1Division of Critical Care Cardiology, Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA.
酸干扰,特别是代谢性酸症,加剧了心脏性休克患者在静脉外体膜氧化的结果. 对代谢障碍的早期干预对于改善生存至关重要.
科学领域:
- 心脏病学 心脏病学
- 关键护理医学 关键护理医学
- 生物化学 生化学
背景情况:
- 在静脉外体膜氧化 (VA-ECMO) 的心脏性休克患者中,酸平衡的预后意义尚不清楚.
- 该研究使用ELSO注册表调查了VA-ECMO耐心心脏性休克患者的代谢和呼吸系统障碍.
研究的目的:
- 在VA-ECMO启动后24小时分析酸干扰.
- 在这个患者群体中确定住院死亡率的预测因素.
主要方法:
- 在VA-ECMO后24小时分析动脉血液气体数据 (pH,PaCO2,二碳酸盐).
- 根据酸状态对患者进行分类.
- 多变量逻辑回归和机器学习用于死亡率预测.
主要成果:
- 分析了超过15,000名患者; 74.6%的人没有化症,13.1%的呼吸,11.6%的代谢和0.7%的综合.
- 住院死亡率为51.0%,随着pH值降低,二碳酸盐和基过多而增加.
- 最低pH的代谢性化群体显示死亡率最高 (aOR1.90).
结论:
- 尽管VA-ECMO在心脏性休克中存在,但随着酸性血或代谢性酸的恶化,生存率下降.
- 代谢参数是显著的,潜在的可修改的预后因素.
- 对于严重的代谢障碍的早期识别和干预至关重要.
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