Retrospective Analysis Of Changes Of Liver And Renal Function,inflammation Indexes And Complications During Extracorporeal Membrane Oxygenation In 21 Adults

Objective To investigate the changes of liver and renal function,inflammatory indexes and complications during extracorporeal membrane oxygenation.Methods The basic data of 21 critically ill patients with adult heart failure and/or respiratory failure treated with ECMO from March 2016 to September 2019 in the intensive care units of the Second Affiliated Hospital of Nanchang University were retrospectively analyzed,as well as the liver function(AST,ALT,TBIL,DBIL,IBIL),renal function(BUN,SCr,UA,GFR)and inflammatory indexes(CRP,WBC,NEUT%,PCT)before and 24 hours,48 hours and 72 hours after ECMO was established.At the same time,patients were divided into survival group and death group according to whether in-hospital death occurred,and the changes of various indexes and complications in the two groups were compared.The risk factors of death were analyzed by binary logistic regression.Results Of the 21 patients,13 were successfully weaned,with a weaning rate of61.90%,of which 6 were recovered and discharged,with a discharge rate of 28.57%.7 patients died in-hospital.8 patients were discharged from hospital automatically because their families gave up treatment due to difficulties in weaning,sharp deterioration of their condition or cost problems,etc.Compared with death group,BUN,SCr and GFR in survival group had statistical difference during ECMO(P<0.05),among which BUN and SCr in death group increased significantly and GFR decreased significantly.Binary logistic regression analysis showed that BUN and GFR were risk factors of death.According to the basic data,liver function and inflammation indexes had no statistical difference before ECMO and at 24 h,48h and72 h after ECMO was established(P>0.05),but bilirubin level in death group increased significantly,while CRP and PCT in survival group decreased significantly.The most common complications during ECMO were liver insufficiency in 16 cases(76.19%),infection in 13 cases(61.90%),hyperbilirubinemia in 12 cases(57.14%),hemorrhage in 12 cases(57.14%),multiple organ failure in 9 cases(42.86%),renal insufficiency in 9 cases(42.86%).Mechanical complications were membrane lung replacement in 13 cases(61.90%)and oxygenator leakage in 3 cases(14.29%).Among them,any complications and multiple organ failure are related to the death of patients,and the death group is more than the survival group in both kinds and quantities of complications.Conclusion This study did not find that changes of liver function and inflammatory indexes during ECMO were related to death,but bilirubin level in death group increased significantly,while CRP and PCT in survival group decreased significantly.BUN,GFR,SCr,any complications and multiple organ failure are related to death,of which BUN and GFR are risk factors for death.There are many quantities of complications during ECMO,which should be closely monitored and prevented.