目的：本研究旨在回顾性分析ECMO相关并发症的发生率及其与患者预后的相关性。方法：纳入自2012年1月1日至2019年12月31日期间东南大学附属中大医院重症医学科所有接受ECMO治疗的患者。根据出院存活情况将入组患者分为存活组和死亡组。比较两组患者临床特点差异，尤其是并发症的发生率，并通过多因素回归分析探讨患者预后的危险因素。结果：本研究共纳入173例患者，其中存活组92例，死亡组81例。统计发现急性肾损伤（AKI）发生率高达33.5%，全身性出血发生率约24.2%，急性肝功能不全发生率16.2%，局部渗血发生率约13.9%，血流感染发生率12.7%，其余并发症如下肢缺血、机器故障等发生率均不足5%。与存活组相比，死亡组患者AKI （44.4%vs.23.9%，P=0.005）和急性肝功能不全（22.2%vs. 10.9%，P=0.047）发生率显著升高。多因素Logistic回归分析显示全身性出血（OR=4.93，95%CI 1.93~12.58，P=0.001）与患者住院病死率增高存在明显相关性。结论：ECMO治疗期间死亡组患者AKI和急性肝功能不全的发生率显著高于存活组患者，全身出血并发症是患者不良预后的独立危险因素。

[1] NOAH M A, PEEK G J, FINNEY S J, et al.Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1)[J].JAMA, 2011, 306(15):1659-1668.
[2] BRODIE D, BACCHETTA M.Extracorporeal membrane oxygenation for ARDS in adults[J].N Engl J Med, 2011, 365(20):1905-1914.
[3] POPUGAEV K A, BAKHAREV S A, KISELEV K V, et al.Clinical and pathophysiologic aspects of ECMO-associated hemorrhagic complications[J].PLoS one, 2020, 15(10):e0240117-0240130.
[4] BARBARO R P, ODETOLA F O, KIDWELL K M, et al.Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality:analysis of the extracorporeal life support organization registry[J].Am J Respir Crit Care Med, 2015, 191(8):894-901.
[5] KELLUM J A, LAMEIRE N, The Kdigo AKI Guideline Work Group.Diagnosis, evaluation, and management of acute kidney injury:a KDIGO summary(part 1)[J].Crit Care, 2013, 17(1):204-219.
[6] SULLIVAN J I, ROCKEY D C.Diagnosis and evaluation of hyperbilirubinemia[J].Curr Opin Gastroenterol, 2017, 33(3):164-170.
[7] ASO S H, MATSUI1 H, FUSHIMI K, et al.In-hospital mortality and successful weaning from venoarterial extracorporeal membrane oxygenation:analysis of 5, 263 patients using a national inpatient database in Japan[J].Crit Care, 2016, 20:80-87.
[8] ENGER T B, PHILIPP A, LUBNOW M, et al.Long-term survival in adult patients with severe acute lung failure receiving veno-eenous extracorporeal membrane oxygenation[J].Crit Care Med, 2017, 45(10):1718-1725.
[9] MCMICHAEL A B V, RYERSON L M, RATANO D, et al.2021 ELSO adcult and pediatric anticoagulation guidelines[J].ASAIO J, 2022, 68(3):303-310.
[10] AUBRON C, DEPUYDT J, BELON F, et al.Predictive factors of bleeding events in adults undergoing extracorporeal membrane oxygenation[J].Ann Intensive Care, 2016, 6(1):97-107.
[11] CAVAYAS Y A, MUNSHI L, SORBO L D, et al.The early change in PaCO₂ after extracorporeal membrane oxygenation initiation is associated with neurological complications[J].Am J Respir Crit Care Med, 2020, 201(12):1525-1535.
[12] LUYT C E, BRÉCHOT N, DEMONDION P, et al.Brain injury during venovenous extracorporeal membrane oxygenation[J].Intensive Care Med, 2016, 42(5):897-907.
[13] ALI J M, ABU-OMAR Y.Complications associated with mechanical circulatory support[J].Ann Transl Med, 2020, 8(13):835-849.
[14] THONGPRAYOON C, CHEUNGPASITPORN W, LERTJITBANJONG P, et al.Incidence and impact of acute kidney injury in patients receiving extracorporeal membrane oxygenation:a meta-analysis[J].J Clin Med, 2019, 8(7):981-1006.
[15] 文职斌, 崔晓光.体外循环相关急性肾损伤的研究进展[J].现代医学, 2016, 44(1):147-150.
[16] 杨啸天, 沈振亚, 胡雁秋.CRRT治疗46例心脏直视手术后急性肾损伤的临床分析[J], 现代医学, 2016, 44(9):1306-1308.
[17] CHEN Y C, TSAI F C, CHANG C H, et al.Prognosis of patients on extracorporeal membrane oxygenation:The impact of acute kidney injury on mortality[J].Ann Thorac Surg, 2011, 91(1):137-142.
[18] ASKENAZI D J, AMBALAVANAN N, HAMILTON K, et al.Acute kidney injury and renal replacement therapy independently predict mortality in neonatal and pediatric noncardiac patients on extracorporeal membrane oxygenation[J].Pediatr Crit Care Med, 2011, 12(1):e1-6.
[19] ZWIERS A J, DE WILDT S N, HOP W C, et al.Acute kidney injury is a frequent complication in critically ill neonates receiving extracorporeal membrane oxygenation:a 14-year cohort study[J].Crit Care, 2013, 17(4):R151-161.