超声在急性呼吸窘迫综合征围静脉-静脉体外膜氧合期中的应用价值

Application value of ultrasound in the veno-venous extracorporeal membrane oxygenation stage in acute respiratory distress syndrome

目的探讨经胸超声心动图、血管超声及腹部超声在急性呼吸窘迫综合征(ARDS)患者围静脉-静脉体外膜氧合(V-V ECMO)期的临床应用价值。方法选取我院拟行V-V ECMO支持治疗的ARDS患者13例,分析超声在插管前对患者基本情况的评估结果,以及在插管过程中、V-V ECMO支持治疗期间和脱机后对心脏及血管相关并发症监测情况。结果行V-V ECMO支持治疗的13例ARDS患者中,12例存活至脱机,8例存活至康复出院。V-V ECMO插管过程中,7例在超声引导下调整套管末端位置;V-V ECMO支持治疗期间,2例在超声引导下调整套管末端位置。并发症发生情况:V-V ECMO支持治疗期间血管超声提示2例套管周围血栓形成,腹部超声提示1例腹腔出血;脱机后超声心动图提示1例下腔静脉附壁血栓形成,血管超声提示1例插管同侧下肢深静脉血栓形成。围V-V ECMO期无严重不良事件发生。结论超声在V-V ECMO插管过程中、支持治疗期间及监测并发症方面均具有重要价值。

Objective To explore the application value of transthoracic echocardiography,vascular ultrasound and abdominal ultrasound in patients with acute respiratory distress syndrome(ARDS)in the veno-venous extracorporeal membrane oxygenation(V-V ECMO)stage.Methods Thirteen patients with ARDS who were proposed to be treated with V-V ECMO support in our hospital were selected.To summarize and analyze the results of patients’basic condition by echocardiography,vascular ultrasound and abdominal ultrasound before intubation were summarize and analyze,as well as the monitoring of cardiac and vascular complications during intubation,during ECMO supportive treatment and after weaning.Results Of the 13 patients with ARDS treated with V-V ECMO support,12 survived to offline and 8 survived to recovery and discharge.During ECMO assisted and supportive treatment,7 cases needed ultrasonic guidance to adjust the position of the cannula end.During ECMO supportive treatment,ultrasonic guided cannula end position was required in 2 cases.Occurrence of complications:during ECMO supportive treatment,2 cases of vascular ultrasound indicated thrombus formation around the cannula,and 1 case was abdominal hemorrhage.After weaning-off,echocardiography indicated that mural thrombus of inferior vena cava in 1 case and deep vein thrombosis of ipsilateral lower extremities in 1 case.No adverse events occurred during the V-V ECMO period.Conclusion Ultrasound plays an important role in V-V ECMO intubation,during adjuvant and supportive treatment,and in the early detection of complications.