川北医学院学报2026，Vol.41Issue(1)：47-51,5.DOI:10.3969/j.issn.1005-3697.2026.01.010
VIS评分对心源性休克患者VA-ECMO辅助撤机预测的价值
The value of VIS score in predicting VA-ECMO assisted weaning in patients with cardiogenic shock
摘要
Abstract
Objective:To explore the clinical application value of vasoactive-inotropic score(VIS)in predicting veno-arterial extracorporeal membrane oxygenation(VA-ECMO)assisted weaning in patients with cardiogenic shock.Methods:This study was a retrospective single-center cohort study,including patients who received VA-ECMO treatment for cardiogenic shock.A total of 495 patients received ECMO treatment,and 150 patients met the criteria and were included in the analysis.The demographic characteristics,underlying diseases,etiology,clinical conditions,APACHE II score,lactic acid level and VIS score of the patients were collected,and the differences between the two groups were compared.The independent predictors were analyzed by multivariate Logistic regression,and the ROC curve and subgroup analysis were further drawn to evaluate the predictive efficacy of VIS.Results:A total of 150 patients with CS receiving VA-ECMO were included,of whom 84(56.0%)were successfully weaned and 66(44.0%)failed.The proportion of acute myocardial infarction was higher in the failure group,while myocarditis was more common in the success group.The rates of concomitant CRRT and APACHE II scores were higher in the failure group(P<0.001).Regarding hemodynamic and metabolic indicators,lactate levels and VIS scores before ECMO and at 24 hours were lower in the success group,while lactate clearance and VIS reduction rates were higher(P<0.001).Multivariate Logistic regression analysis(with weaning failure as the outcome event)showed that the 24-hour VIS reduction rate was an independent protective factor against weaning failure(OR<1,P<0.001),whereas APACHE II score,24-hour VIS,24-hour lactate level,and pre-ECMO VIS were independent risk factors(OR>1,P<0.05).ROC curve analysis demonstrated that the 24-hour VIS reduction rate had the highest predictive value for weaning outcome(AUC=0.780).A combined prediction model incorporating the 24-hour VIS reduction rate,APACHE II score,VIS,and lactate indicators further improved predictive performance(AUC=0.820).Subgroup analyses indicated that this prediction model maintained consistent predictive value across different etiologies,CPR statuses,and CRRT conditions.Conclusion:VIS,especially the VIS value of ECMO 24 hours,is an important index to predict the outcome of VA-ECMO weaning in patients with cardiogenic shock,and can be used as a powerful tool for clinical evaluation of the possibility of successful weaning.关键词
心源性休克/体外膜肺氧合/撤机/血管活性药物-正性肌力评分/乳酸/预后Key words
Cardiogenic shock/Extracorporeal membrane oxygenation/Weaning/vasoactive-inotropic score/Lactic acid/Prognosis分类
医药卫生引用本文复制引用
卢广轩,李盘石,范彦琦,杨淑娟,贾伯康,沈利汉..VIS评分对心源性休克患者VA-ECMO辅助撤机预测的价值[J].川北医学院学报,2026,41(1):47-51,5.基金项目
广东省基础与应用基础研究基金区域联合基金-重点项目(2020B151512004) （2020B151512004）
广东省东莞市社会发展科技重点项目(20221800906292) （20221800906292）
