体外膜肺氧合血管插管相关并发症及预防

Cannulation related complications and prevention for extracorporeal membrane oxygenation： clinical report and reviews of experience of 34 cases

目的回顾性分析体外膜肺氧合（ECMO）血管插管并发症及转归，探讨此类并发症发生原因和防治措施。方法从2007年1月至2012年12月，共对34例心肺功能不全的患者（男性21例，女性13例，年龄23—66岁）进行了ECMO辅助，分析直视切开、半切开辅助Seldinger技术及单纯Seldinger技术三种不同插管方法中插管相关出血、下肢缺血等并发症的发生和预防。结果34例患者辅助2～21d，24例（70．6％）成功脱机，18例（52．9％）痊愈出院。其中静脉一动脉与静脉一静脉模式分别为26例和8例。8例患者（30．8％）出现不同程度下肢缺血，其中直视切开术6例，半切开辅助Seldinger技术2例；3例患者因下肢缺血时间较长，1例发生间歇性跛行，2例截肢。6例患者（23．1％）出现股动脉损伤，其中2例行血管重建，4例行血管修复，预后良好。2例出现股动脉栓塞，撤机行取栓术后恢复。11例患者（42．3％）出现插管部位出血，经外科处理后好转。结论选择内径适中的插管、最佳的插管方法和插管部位，酌情及时建立远端侧支灌注通路，早期发现并积极干预是预防和治疗ECMO插管相关并发症的关键。

Objective To review the cannulation strategies and associated vascular complications of extracorporeal membrane oxygenation （ECMO） and to investigate the etiology and preventive procedures for those complications. Methods From January 2007 to December 2011, 34 patients （21 male and 13 female patients, aged from 23 to 66 years ） underwent ECMO support through open approach, semi-Seldinger method or full Seldinger method of cannulation. Bleeding and limb ischemia related to the approach as major complications were retrospectively analyzed. Results The ECMO duration were 2 to 21 days. Twenty-four patients （70. 6% ） successfully weaned from ECMO and 18 patients （52.9%） discharged. The venoarterial mode was used in 26 patients, and venovenous mode in 8 patients. Eight patients （30. 8% , 6 for open approach and 2 for semi-seldinger） observed with limb ischemia, 2 of them required amputation, 1 had claudicatory sequela. Eleven and 6 patients suffered from bleeding and vessel injury respectively, all of them recovered by suitable treatment. Conclusions The proper size of cannula, optimal approch and position adjustment, accurate cannula placement and carefully attendance are the key points to decrease the cannulation related complications.