体外膜肺氧合治疗危重症新型冠状病毒肺炎和新型甲型H1N1流感病毒性肺炎临床特征和预后比较

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目的:对接受体外膜肺氧合(ECMO)治疗的新型冠状病毒肺炎(新冠肺炎)和新型甲型H1N1流感病毒性肺炎(流感肺炎)患者的临床特征和预后进行比较。方法:将2016年3月至2019年12月于首都医科大学附属北京朝阳医院呼吸重症监护病房(ICU)接受ECMO治疗的24例流感肺炎患者和2020年2月1日至3月31日于北京、河北等5家定点医院接受ECMO治疗的12例新冠肺炎患者纳入研究。收集两组患者基本情况、临床表现和ECMO治疗相关情况等资料并进行描述和比较,所有连续变量均以n M(n P25,n P75)描述。n 结果:新冠肺炎患者年龄为77(66,79)岁,高于流感肺炎患者[46(32,62)岁],n P<0.05;急性肺损伤评分和建立ECMO前的呼吸ECMO存活预测量表评分分别为3.3(3.0,3.5)和1(0,2)分,均低于流感肺炎患者[分别为3.8(3.5,4.0)分和4(2,6)分](n P值均<0.05)。接受ECMO治疗的新冠肺炎患者血栓并发症、出血并发症和呼吸机相关性肺炎发生例数分别为4、10和5例,发生率均高于流感肺炎患者[分别为1、9和2例],n P值均<0.05。新冠肺炎患者ICU住院时间n M(n P25,n P75)为31(28,75) d,长于流感肺炎患者[27(18,39) d],n P0.05)。n 结论:与流感肺炎患者相比,接受ECMO支持治疗的新冠肺炎患者ECMO相关并发症较多且ICU住院时间较长。“,”Objective:To compare the clinical characteristics and prognosis of critical patients with COVID-19 and novel influenza A (H1N1) virus pneumonia (influenza pneumonia) applied with extracorporeal membrane oxygenation (ECMO).Methods:A total of 24 patients with influenza pneumonia treated with ECMO in respiratory intensive-care unit (ICU) of Beijing Chaoyang Hospital from March 2016 to December 2019 and 12 patients with COVID-19 hospitalized from February 1, 2020 to March 31, 2020 in 5 government designated infectious hospitals of Beijing and Hebei Province that applied with ECMO were enrolled. The demographic data, clinical manifestations, and ECMO related information were described and analyzed and all numerical variables are described as n M (n P25, P75).n Results:The age of COVID-19 patients was 77 (66, 79) years old, which was older than influenza pneumonia patients [46 (32, 62) years old], n P<0.05; acute lung injury score and respiratory ECMO survival prediction (RESP) score before ECMO application were 3.3 (3.0, 3.5) and 1 (0, 2), respectively, which were lower than influenza pneumonia patients [3.8 (3.5, 4.0) and 4 (2, 6), respectively], alln P values<0.05. Thrombotic complications, bleeding complications, and ventilator-associated pneumonia occurred in ECMO applied COVID-19 patients were 4, 10 and 5 cases, respectively, which were more than that among influenza pneumonia patients (1, 9, and 2 cases, respectively), alln P values<0.05. The length of ICU stay of COVID-19 patients was 31 (28, 75) d, which was longer than that of influenza pneumonia patients [27 (18, 39) d],n P0.05).n Conclusion:COVID-19 patients applied with ECMO have more ECMO-related complications and a longer stay in the ICU than patients with influenza pneumonia.
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