経皮的心肺補助装置導入後24時間以内の最大乳酸値および最小乳酸値はICU内死亡の予測因子である：後方視的観察研究

Introduction: Lactate level and clearance were hypothesized to be potential prognostic factors for mortality in patients with refractory cardiogenic shock who underwent veno-arterial (VA) extracorporeal membrane oxygenation (ECMO). This study aimed to determine the prognosis of VA-ECMO patients and whether the lactate level at intensive care unit (ICU) admission(La) and at 24 h after VA-ECMO induction (L24), minimum (L24min) or maximum (L24max) lactate level within 24 h after VAECMO induction, and/or maximum lactate level after ICU admission (Lmax) could predict ICU mortality in VA-ECMO patients.Materials and Methods: This retrospective observational study included consecutive patients who underwent VA-ECMO for severe cardiogenic shock and admitted to the ICU in a hospital from April 2009 to March 2017. Risk factors for ICU mortality with respect to lactate levels after VA-ECMO induction were determined through multiple logistic regression analysis.Results: VA-ECMO induction was performed in 67 adult patients, of whom 23 (34.3%) survived to ICU discharge. La, L24min,L24max, and Lmax were risk factors for ICU mortality in VA-ECMO patients after adjustment for the Acute Physiology and Chronic Health Evaluation II score and use of continuous renal replacement therapy and refractory ventricular arrhythmia after VA-ECMO induction, which were confounding factors in univariate analysis (La: odds ratio [OR], 1.44; 95% confidence interval[CI], 1.13-2.05; L24min: OR, 1.20; 95% CI, 1.01-2.56; L24max: OR, 1.44; 95% CI, 1.11-2.02; Lmax: OR, 1.52; 95% CI, 1.14-2.21).Conclusion: Lactate levels can be a therapeutic target and indicator of the need for improved patient management after VAECMO induction.長崎大学学位論文 学位記番号:博(医歯薬)甲第1203号 学位授与年月日:令和2年3月4日Author: Ushio Higashijima, Motohiro Sekino, Takashi Egashira, Rintaro Yano, Haruka Inoue, Sojiro Matsumoto, Shuhei Matsumoto, Shuntaro Sato, Tetsuya HaraCitation: Acta medica Nagasakiensia, 63(2), pp.61-69; 202