ECMO在心血管药物中毒救治中的应用

张云; 张晶; 高霏; 李小林; 王群文; 郑蕾

doi:10.13201/j.issn.1009-5918.2020.10.013

ECMO在心血管药物中毒救治中的应用

- 南京医科大学附属无锡人民医院急诊医学科(江苏无锡, 214023)
基金项目:
无锡市临床重点专科建设项目(No:2017-21)

详细信息

通讯作者: 郑蕾,E-mail:43017541@qq.com

中图分类号: R631.4

收稿日期: 2020-05-25

The application of ECMO in the treatment of cardiovascular agents poisoning

- Department of Emergency, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, 214023, China

More Information

Corresponding author: ZHENG Lei, E-mail: 43017541@qq.com

Received Date: 25 May 2020

摘要

摘要: 目的:文献汇总评价体外膜肺氧合(ECMO)技术在急性心血管类药物过量或中毒中的应用价值及治疗效果。方法:计算机检索PubMed、中国知网、万方、维普等数据库中在2019年12月前公开发表的有关ECMO技术治疗因心血管类药物中毒的急诊危重症患者的研究报道。提取患者的基本信息、中毒途径、药物治疗情况,ECMO应用模式、时间、血液净化模式,并发症、住院时间等信息。采用SPSS 26.0进行统计分析。结果:最终纳入39篇文献,共涉及49例患者,其中45例采用VA-ECMO模式,4例采用VV-ECMO模式。主要适应证包括心源性休克(38例)、心跳骤停(16例)、致命性心律失常(10例)等;从暴露到开始进行ECMO的时间(Tp)中位数为14(4,24) h,应用ECMO时间(Te)中位数为72(36,120) h。最终存活出院39例,死亡10例(20.41%),存活组与死亡组Tp、Te差异无统计学意义(P>0.05)。29例患者报告了并发症,其中主要包括急性肾功能不全15例,出血相关并发症10例,肺水肿及急性呼吸窘迫综合征(ARDS)9例等。二分类Logistic回归分析显示酸中毒可能是患者预后不良的危险因素(P=0.038)。存活组与死亡组在住院时间上差异有统计学意义[(26.8±25.9) d vs.(5.1±3.9) d,P<0.01]。结论:ECMO技术可作为心血管类药物中毒患者出现心源性休克、心跳骤停或致命性心律失常等情况时有效的抢救治疗措施,当出现严重酸中毒时提示患者预后不良。
- 体外膜肺氧合 /
- 心血管系统 /
- 药物中毒 /
- 心源性休克
Abstract: Objective:To evaluate the application scope and effect of extracorporeal membrane oxygenation(ECMO) in acute cardiovascular agents poisoning. Method:We retrieved the research reports published before December 2019 on the application of ECMO in the treatment of critical emergency patients induced by cardiovascular agents poisoning in the databases of the national library of medicine of the United States(PubMed), China national knowledge network(CNKI), Wanfang and VIP databases. The basic information, poisoning route, drug treatment, ECMO application mode, time, ECMO blood purification mode, complications and length of hospital stay of patients were extracted. SPSS 26.0 software was used for statistical analysis. Result:A total of 39 articles were included, and 49 patients were included. 45 patients used VA-ECMO mode and 4 patients used VV-ECMO mode. Main indications included cardiogenic shock(38 cases), cardiac arrest(16 cases) and fatal arrhythmia(10 cases). The median time from exposure to ECMO(Tp) was 14(4, 24) h, and the median time to ECMO(Te) was 72(36, 120) h. 39 cases survived and discharged from hospital and 10 cases died(20.41%). There was no statistically significant difference in Tp and Te between the survival group and the death group(P>0.05). Complications were reported in 29 patients, including 15 patients with acute renal insufficiency, 10 patients with hemorrhage-related complications, and 9 patients with pulmonary edema and acute respiratory distress syndrome(ARDS). Binary Logistic regression analysis showed that acidosis may be a risk factor for poor prognosis(P=0.038). The difference in length of hospital stay between the survival group(26.8±25.9 d) and the death group(5.1±3.9 d) was statistically significant(P<0.01).Conclusion:ECMO technology can be used as an effective rescue and treatment method for patients with drug-induced cardiogenic shock, cardiac arrest or fatal arrhythmia induced by cardiovascular drug poisoning or overdose. The occur of severe acidosis indicated that the prognosis of the patients is poor.
- extracorporeal membrane oxygenation /
- cardiovascular /
- agent poisoning /
- cardiogenic shock

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