作者：扎亚，王宝珠，阿迪拉·阿扎提

单位：

新疆医科大学第一附属医院心内科

Units：

Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China

关键词：

体外膜氧合作用; 输血; 感染; 死亡; 影响因素分析;

Keywords：

Extracorporeal membrane oxygenation; Blood transfusion; Infections; Death; Root cause analysis

CLC：

R 654.1

DOI：

10.12114/j.issn.1008-5971.2023.00.012

Funds：

摘要：

目的 分析输血治疗与接受体外膜肺氧合（ECMO）治疗患者发生院内感染及死亡的关系。方法 回顾性选取2017年12月至2022年7月在新疆医科大学第一附属医院住院并接受ECMO治疗的成年患者83例为研究对象。所有患者接受动脉-静脉体外膜肺氧合（VA-ECMO）治疗，患者如在ECMO治疗过程中发生大量失血（出血量>20ml/kg），则进行输血治疗。收集患者的临床资料，根据患者是否进行输血治疗，将其分为输血组（n=45）和未输血组（n=38）。采用多因素Logistic回归分析探讨接受ECMO治疗患者发生院内感染、死亡的影响因素。结果 输血组心源性休克发生率、联合主动脉内球囊反搏（IABP）治疗者占比、ECMO治疗前进行心肺复苏者占比和ECMO治疗后白细胞计数（WBC）、中性粒细胞计数（N）、国际标准化比值（INR）、天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、乳酸及院内感染发生率、死亡率高于未输血组，ECMO治疗前血红蛋白（Hb）、红细胞计数（RBC）、血小板计数（PLT）和ECMO治疗后Hb、RBC、PLT、纤维蛋白原（FIB）、白蛋白低于未输血组（P<0.05）。多因素Logistic回归分析结果显示，输血治疗是接受ECMO治疗患者发生院内感染的影响因素[OR=5.499,95%CI(1.451,21.848),P<0.05]；ECMO治疗后左心室射血分数[OR=0.899,95%CI(0.816,0.991)]、乳酸[OR=1.595,95%CI(1.120,2.269)]是接受ECMO治疗患者死亡的影响因素（P<0.05）。结论 输血治疗是接受ECMO治疗患者发生院内感染的危险因素，而与患者死亡无关。

Abstract：

Objective To analyze the relationship between blood transfusion therapy and nosocomial infection and death in patients receiving extracorporeal membrane oxygenation (ECMO) . Methods A total of 83 adult patients who were hospitalized in the First Affiliated Hospital of Xinjiang Medical University and received ECMO treatment from December 2017 to July 2022 were retrospectively selected as the study subjects. All patients received venous-arterial extracorporeal membrane oxygenation (VA-ECMO) treatment. If a large amount of blood loss ( > 20 ml/kg of blood loss) occurred during the ECMO treatment, patients should receive blood transfusion therapy. The clinical data of patients were collected and patients were divided into blood transfusion group (n=45) and non blood transfusion group (n=38) according to whether they received blood transfusion therapy. Multivariate Logistic regression analysis was used to investigate the influencing factors of nosocomial infection and death in patients receiving ECMO treatment. Results The incidence of cardiogenic shock, the proportion of patients treated with intra aortic balloon pump (IABP) , the proportion of patients undergoing cardiopulmonary resuscitation before ECMO treatment, white blood cell count (WBC) , neutrophil count (N) , international normalized ratio (INR) , aspartate transaminase (AST) , alanine aminotransferase (ALT) and lactic acid after ECMO treatment, the incidence of nosocomial infection and mortality in the blood transfusion group were higher than those in the non blood transfusion group, hemoglobin (Hb) , red blood cell count (RBC) and platelet count (PLT) before ECMO treatment and Hb, RBC, PLT, fibrinogen (FIB) and albumin after ECMO treatment in blood transfusion group were lower than those in non blood transfusion group (P < 0.05) . Multivariate Logistic regression analysis showed that blood transfusion therapy was an influencing factor of nosocomial infection in patients receiving ECMO treatment [ OR =5.499, 95%CI (1.451, 21.848) , P < 0.05] ; left ventricular ejection fraction [OR=0.899, 95%CI (0.816, 0.991) ] and lactic acid [OR=1.595, 95%CI (1.120, 2.269) ] after ECMO treatment were influencing factors of the death of patients receiving ECMO treatment (P < 0.05) . Conclusion Blood transfusion therapy was a risk factor for nosocomial infection in patients receiving ECMO treatment, but was not associated with death.

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