体外膜肺氧合支持下肢并发症分析

目的：总结体外膜肺氧合（ECMO）支持治疗时出现的下肢并发症种类及临床特点。方法回顾性分析74例心脏术后患者及15例接受体外膜肺氧合支持治疗的重症心肌炎患者临床资料。结果下肢并发症主要包括动脉缺血、静脉回流障碍、假性股动脉瘤形成、外周神经损伤。15例重症心肌炎患者中5例出现下肢并发症，发生率为33.3%，其中动脉缺血1例，静脉回流障碍2例，假性股动脉瘤形成1例，外周神经损伤1例（包括腓总神经与胫神经）。既往文献报道的74例接受ECMO支持的患者中，10例出现下肢并发症，发生率为13.5%，其中3例动脉缺血，7例静脉回流障碍。下肢并发症总发生率为16.9%。结论下肢并发症常表现为肢体肿胀、皮温低、花斑、足背动脉搏动消失、足下垂、反复出血。做到以下几点对预防下肢并发症有帮助：（1）插管前行下肢血管彩超检查评估血管宽度及深度。（2）选择大小合适的动静脉插管。（3）首选经皮动静脉插管。（4）避免动静脉切开插管。

ObjectiveTo summarize the species and clinical characteristics of leg complication in supporting of extracorporeal membrane oxygenation.Methods 74 patients after cardiac surgery and and 15 serious myocarditis patients from the central hospital of JinHua city were reviewed,who accepted the supporting of exrtacorporeal membrane oxygenation.Results The leg complication consisted of arterial ischemia, venous return disord,femoral aneurysm becoming and peripheral nerve injury. 5 patients had leg complication out of the 15 patients who accepted the supporting of exrtacorporeal membrane oxygenatiaon,the incidence rate was 33.3%. One patient appears arterial ischemia,two patients had venous return disordor,one patient had femoral aneurysm,and another one patient had peripheral nerve injury. 10 patients had leg complication out of the 74 patients who accepted the supporting of extracorporeal membrane oxygenation in the previous articles,the incidence rate was 13.5%.Three patients appear arterial ischemia and seven patients appear venous return disord. The total incidence rate of leg complication is 16.9%.Conclusions The manifestation of leg complication consists of leg swelling,lower skin temperature,anthophaein,dorsal artery of foot beating disappear,footdrop, repeated bleeding. Doing following things can help to prevent the complication of the legs：（1）Evaluate the width and depth of the blood vessel by ultrasonography before intubating.（2）Choose sizable vascular tube.（3）Intubating per cutem is first considered.（4）Avoid intubating by cutting the blood vessel.