Side Graft灌注技术在成人股动静脉VA-ECMO中的应用

Application of Side Graft Perfusion Technology in Adult Femoral VA-ECMO Cannulation

目的探讨人工血管端侧吻合至股动脉,经人工血管插入ECMO供血管的方法(Side Graft),对改善远端肢体并发症的作用。方法收集行VA-ECMO的病例,排除了经中心插管的病例,共32例(其中使用股动脉Side Graft技术的11例,对照组21例)。分析两组病人特点及比较主要并发症情况。结果 Side Graft组与对照组相比,撤机率(54. 5%vs 28. 6%)和出院率(36. 4%vs 14. 3%)均不具有统计学意义。插管部位出血需要外科干预的,Side Graft组更多(36. 4%vs 4. 8%,P=0. 04),其余主要并发症无统计学意义。结论 Side Graft技术能够一定程度防止下肢缺血并发症,但是手术操作需要一定时间,不适合血流动力学无法维持甚至需要CPR的病人。股动脉使用Side Graft技术不容易出现远端奢灌的问题。

Objective To investigate the effects of side graft perfusion technology on the improvement of distal limb complications. Methods 32 cases with the treatment of VA-ECMO were collected,including 11 cases performed with femoral artery side graft technology and 21 cases of control. The characteristics and major complications of the two groups were compared and analyzed. Results There was no statistical significant difference between the side graft group and control group in weaning rate( 54. 5% vs 28. 6%) and survival rate( 36. 4% vs14. 3%). More cases with the symptom of bleeding at the cannulation site that required surgical intervention occurred inside graft group than that in control group( 36. 4% vs 4. 8%,P = 0. 04),but no statistical significance was found in other major complications. Conclusion Side graft technology can prevent lower limb ischemic complications to a certain extent,but the related operation requires certain time. Therefore,it is not suitable for patients with hemodynamic failure and in need of CPR. Notably,the application of side graft technology in femoral artery contributes to less problems of distal hyper-perfusion.