Longtime Neurologic Outcome of Extracorporeal Membrane Oxygenation and Non Extracorporeal Membrane Oxygenation Acute Respiratory Distress Syndrome Survivors
Longtime Neurologic Outcome of Extracorporeal Membrane Oxygenation and Non Extracorporeal Membrane Oxygenation Acute Respiratory Distress Syndrome Survivors
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DOI：
10.3390/jcm8071020
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发表时间：
2019-07-01
影响因子：
3.9
通讯作者：
Moerer, Onnen
中科院分区：
文献类型：
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作者：
Harnisch, Lars-Olav;Riech, Sebastian;Moerer, Onnen
急性呼吸窘迫综合征（ARDS）后的神经系统并发症已得到充分描述，然而，关于危重ARDS患者（尤其是接受体外膜肺氧合（ECMO）的患者）周围神经系统并发症的神经系统结局的信息缺乏。在这项前瞻性观察性研究中，对28例经ECMO或常规非ECMO治疗后存活的ARDS患者进行了神经系统检查。9例患者有与颅神经支配相关的发现，ECMO和非ECMO患者之间存在差异（p = 0.031）。ECMO患者的髌腱反射（PTR）水平严重增加（p = 0.027 vs. p = 0.125），右侧腓肠肌腱反射（GTR）（p = 0.041右侧，p = 0.149左侧）受到影响，但左侧未受到影响，推测与ECMO插管相关。仅在ECMO组中发现轻瘫（14.3%的患者）（p = 0.067）。感觉异常是常见的（非ECMO 53.8%，ECMO 62.5%; p = 0.064），在非ECMO中最常见的是由于初始创伤和多发性神经病，在ECMO组中主要是由于N的损伤。股外侧皮（4 vs 0; p = 0.031）。除了众所周知的中枢神经系统并发症，更微妙的并发症被检测到全面的临床检查。这些发现足以妨碍日常生活活动，损害生活质量和心理健康，推测与ECMO治疗直接相关。
Neurologic complications following acute respiratory distress syndrome (ARDS) are well described, however, information on the neurologic outcome regarding peripheral nervous system complications in critically ill ARDS patients, especially those who received extracorporeal membrane oxygenation (ECMO) are lacking. In this prospective observational study 28 ARDS patients who survived after ECMO or conventional nonECMO treatment were examined for neurological findings. Nine patients had findings related to cranial nerve innervation, which differed between ECMO and nonECMO patients (p = 0.031). ECMO patients had severely increased patella tendon reflex (PTR) reflex levels (p = 0.027 vs. p = 0.125) as well as gastrocnemius tendon reflex (GTR) (p = 0.041 right, p = 0.149 left) were affected on the right, but not on the left side presumably associated with ECMO cannulation. Paresis (14.3% of patients) was only found in the ECMO group (p = 0.067). Paresthesia was frequent (nonECMO 53.8%, ECMO 62.5%; p = 0.064), in nonECMO most frequently due to initial trauma and polyneuropathy, in the ECMO group mainly due to impairments of N. cutaneus femoris lateralis (4 vs. 0; p = 0.031). Besides well-known central neurologic complications, more subtle complications were detected by thorough clinical examination. These findings are sufficient to hamper activities of daily living and impair quality of life and psychological health and are presumably directly related to ECMO therapy.