预置Proglide缝合器简化体外膜肺氧合股动脉拔管的单中心回顾性研究

Preclose proglide device simplified the removal femoral arterial cannulas of venoarterial extracorporeal membrane oxygenation: a single center retrospective study

目的探讨预置Proglide缝合器用于静脉-动脉模式的体外膜肺氧合(VA-ECMO)的股动脉拔管的有效性、可行性和安全性。方法回顾性分析2015年1月至2019年1月佛山市第一人民医院57例接受VA-ECMO治疗患者,依据患者股总动脉置管时是否预置Proglide缝合器分成预置缝合器组(P组,26例)和非预置缝合器组(NP组,31例),对比两组患者的基本情况、置管情况和拔管情况的各项指标。结果两组患者基本情况、置管情况差异均无统计学意义。P组的拔管总耗时为(19.18±7.58)min,明显少于NP组的的(75.64±35.66)min(P<0.01);P组拔管部位相关感染发生数(0例)低于NP组(4例,P=0.046);P组拔管相关性失血更少,术后血红蛋白降低值少于NP组[(0.75±0.42)g/Lvs(1.38±0.74)g/L,P=0.037)]。其他指标包括活化凝血时间、下肢缺血、拔管部位渗血、假性动脉瘤、再次手术干预、血小板降低值、拔管后的ICU住院时间、普通病房住院时间及院内死亡率差异均无统计学意义。结论在VA-ECMO股动脉拔管中运用预置Proglide缝合器技术可以缩短拔管操作耗时,减少拔管操作相关失血,降低手术部位感染,可以简化VA-ECMO股动脉拔管操作,有效性、可行性和安全性值得肯定。

Objective To investigate the effectiveness, feasibility and security of preclose Proglide device which was performed to remove the femoral arterial cannulas of venoarterial extracorporeal membrane oxygenation (VA-ECMO). Methods A total of 57 patients treated by VA-ECMO in Foshan First People’s Hospital between January 2015 and January 2019 were analyzed retrospectively. According to whether the preclose Proglide device was performed or not, 26 patients were assigned to preclose group (P group) and 31 patients were assigned to non-preclose group (NP group). The data of general characteristics, femoral arterial cannulas and removal arterial cannulas were compared between groups. Results The data of general characteristics or femoral arterial cannulas was not significantly different between two groups. The procedure duration of removal arterial cannulas was shorter in P group (19.18±7.58 min vs 75.64±35.66 min, P<0.01). The infective complication of removal arterial cannulas was lower in P group (0 case vs 4 case, P=0.046). The procedure-related blood lost was less in P group (Hemoglobin reduction value: 0.75±0.42 g/L vs 1.38±0.74 g/L, P=0.037). A composite of other complications of removal arterial cannulas, length of stay in ICU or public ward, in-hospital mortality was not significantly different between groups. Conclusion Preclose Proglide device could simplify the removal arterial cannulas of VA-ECMO by reducing procedure duration, procedure-related blood lost and infective complication. It is an effective, feasible and safe strategy for removal arterial cannulas.