床旁超声引导穿刺在VA-ECMO置管中的应用

Application of bedside ultrasound-guided puncture in VA-ECMO catheterization

目的:评价床旁超声引导在建立VA模式体外膜肺氧合(VA-ECMO)循环股动静脉置管中的应用效果。方法:选择我院2017-07—2019-09期间收治的86例接受股动静脉置管方式、VA-ECMO模式支持的患者进行研究,按是否使用床旁超声引导置管分为观察组(2018-10—2019-09期间经B超引导下穿刺置管的51例患者)及对照组(2017-07—2018-09期间采用非超声传统体表解剖定位穿刺置管的35例患者)。记录及对比2组患者一次置管成功率、组织损伤情况、建立ECMO循环时间、出/渗血情况、动静脉导管短期/长期并发症、患者ECMO脱机成功率、脱机后28 d生存率、ICU住院时间的情况。结果:与对照组相比,观察组一次穿刺成功率高于对照组(92.16%vs.74.28%),切开置管率、组织损伤、置管时间、穿刺口出/渗血比例、导管相关感染率及ICU住院时间均低于对照组,差异有统计学意义(均P<0.05)。结论:与传统体表解剖定位穿刺置管方式相比,床旁超声引导ECMO穿刺置管可缩短建立ECMO循环时间,减少置管过程中出血量,降低置管相应血管并发症发生率,减少院内感染发病率,缩短患者ICU总住院时间,可安全有效地用于需应用ECMO治疗的患者。

Objective:To evaluate the efficacy of bedside ultrasound-guided femoral arteriovenous catheterization in establishing VA mode extracorporeal membrane oxygenation(VA-ECMO).Method:A total of 86 patients who received femoral arteriovenous catheterization and VA-ECMO mode support in our hospital from July 2017 to September 2019 were selected for the study.According to whether or not to use bedside ultrasound-guided catheterization,they were divided into observation group(ultrasound-guided puncture catheterization,n=51)and control group(non-ultrasonic traditional body surface anatomical positioning puncture catheterization,n=35).The success rate of one-time catheterization,tissue injury,establishment of ECMO circulation time,outflow/extravasation,short-term/long-term complications of arteriovenous catheter,28-day survival rate after ECMO initiation,and length of ICU stay were recorded and compared between the two groups.Result:Compared with the control group,the one-time catheterizing success rate of observation group was higher than that of the control group,and the rate of incision and catheterization,tissue damage,catheterization time,ratio of puncture outlet outflow/extravasation,catheter-related infection rate and length of ICU stay were lower than those of the control group,with statistically significant differences(P<0.05).Conclusion:Compared with traditional catheterizing located by anatomical marks,ECMO with the bedside ultrasound-guided catheterizing shortened the circulation setting-up time of the ECMO reduced blood loss during the process,reduced the incidence of catheter corresponding vascular complications reduced the incidence of nosocomial infection,and shorten the length of ICU stay of patients.The bedside ultrasound-guided puncture and catheterizing in VA-ECMO can be safely and effectively used to treat patients.