临床与病理杂志2025，Vol.45Issue(6)：680-687,8.DOI:10.11817/j.issn.2095-6959.2025.250125
体外膜肺氧合患者凝血功能动态变化与并发症的临床分析
Dynamic changes in coagulation function and clinical analysis of complications in patients undergoing extracorporeal membrane oxygenation
摘要
Abstract
Objective:Changes in coagulation function during extracorporeal membrane oxygenation(ECMO)in critically ill patients are closely related to prognosis.This study aims to investigate the dynamic changes in biochemical indices(especially coagulation function),the occurrence of complications during ECMO,the relationship between these two,and the impact of complications on clinical outcomes. Methods:A retrospective analysis was performed on patients treated with ECMO at Second Xiangya Hospital of Central South University from January 2020 to January 2024.Data collected included demographic characteristics,biochemical indices at different ECMO time points(before cannulation,day 2 after cannulation,day 5 after cannulation-including complete blood count and coagulation parameters),complications,and in-hospital survival.Dynamic changes in biochemical indices at different time points were compared.Spearman correlation was used to evaluate associations between biochemical indices and complications,and multivariate Logistic regression was performed to assess the effect of complications on survival outcomes. Results:Among 76 ECMO patients,18 underwent veno-arterial ECMO(V-A ECMO)and 58 underwent veno-venous ECMO(V-V ECMO);23 survived(30.26％)and 53 died(69.74％).52 patients(68.42％)experienced at least one complication:bleeding in 32(42.1％),thrombosis in 29(38.2％),pneumothorax in 8(10.5％),acute renal failure in 7 cases(9.2％),limb ischemia in 6(7.9％),and 1 case(1.3％)of right superficial femoral artery pseudoaneurysm with arteriovenous fistula.Compared with pre-cannulation,hemoglobin,platelets,serum albumin,and fibrinogen(FIB)significantly decreased on day 2 post-cannulation(all P<0.05),while thrombin time(TT),activated partial thromboplastin time(APTT),prothrombin time(PT),and procalcitonin(PCT)significantly increased(all P<0.05);compared with day 2 post-cannulation,platelets further decreased on day 5(P<0.01),and TT(P<0.01)and APTT(P<0.05)significantly declined but remained higher than baseline.Spearman analysis showed that on day 2 post-cannulation,TT and APTT were negatively correlated with internal bleeding(P<0.01),thrombosis(P<0.05),and circuit thrombosis(P<0.01);PT was negatively correlated with bleeding(r=-0.337,P<0.01),internal bleeding(r=-0.416,P<0.01),and thrombosis(r=-0.259,P<0.05);PCT was positively correlated with bleeding(r=0.261,P<0.05).On day 5 post-cannulation,PT was negatively correlated with bleeding(r=-0.287,P<0.05)and circuit thrombosis(r=-0.293,P<0.05),while D-dimer was positively correlated with limb ischemia(r=0.324,P<0.01).Logistic regression showed that circuit thrombosis was an independent risk factor for mortality[odds ratio(OR)=9.336,95％confidence interval(CI)1.350 to 64.587,P=0.024]. Conclusion:During ECMO,elevated TT,APTT,and PT are significantly negatively correlated with complications such as internal bleeding,thrombosis,and circuit thrombosis,and circuit thrombosis is a risk factor for death.关键词
体外膜肺氧合/凝血功能/并发症/临床结局/血栓Key words
extracorporeal membrane oxygenation/coagulation function/complications/clinical outcomes/thrombosis引用本文复制引用
刘茜凤,曾德华,唐先明,朱爱群..体外膜肺氧合患者凝血功能动态变化与并发症的临床分析[J].临床与病理杂志,2025,45(6):680-687,8.基金项目
湖南省自然科学基金(2023JJ60442).This work was supported by the Natural Science Foundation of Hunan Province,China(2023JJ60442). （2023JJ60442）
