股动-静脉体外膜肺氧合放置下肢灌注管的临床效果分析

The clinical analysis of distal perfusion cannulation placement in femoral veno-arterial extracorporeal membrane oxygenation

目的:总结股动-静脉体外膜肺氧合(V-A ECMO)放置下肢灌注管(DPC)的经验。方法:收集本院自2018年1月-2019年8月期间完成V-A ECMO患者的病例数据,回顾性分析留置下肢灌注管的时机、方式以及预防下肢缺血的效果。结果:34例患者接受V-A ECMO辅助,ECMO平均转机时间105.5 h,共出现下肢缺血并发症患者3例,总发生率约8.8%,均发生在预防性放置DPC组(29例),而在未预防性放置DPC组(5例)(补救性放置DPC 2例,未放置DPC 3例),却未发生下肢缺血。在31例放置DPC患者中,出现DPC堵塞7例(22.5%),DPC置入静脉1例(3.2%),DPC脱落1例(3.2%)。结论:预防性放置PDC并不能完全预防下肢缺血并发症。对于预防性留置DPC的患者,仍需要依赖于严密的床旁监测与临床评估才能有效预防下肢缺血并发症的发生。

Objective:To summarize the experience of distal perfusion cannulation(DPC)placement in femoral veno-arterial extracorporeal membrane oxygenation(ECMO).Methods:We collected the clinical data of V-A ECMO patients in our hospital from January 2018 to August 2019 and retrospectively analyzed the opportunity and method of DPC placement and the effect for preventing limb ischemia.Results:In the total of 34 patients who received femoral V-A ECMO treatment,ECMO average run time was 105.5 h,with 3 cases of limb ischemia complication(total incidence 8.8%)in prophylactic placement group(29 cases),none in no-prophylactic placement group(5 cases,including 2 cases of supplementary DPC and 3 case of no placement DPC).In all 31 patients with DPC,there were 7 cases of DPC blockage,and 3 cases of lower extremity artery occlusion after ECMO weaning.Conclusion:The routine DPC placement couldn’t completely prevent the limb ischemia.Meanwhile rigorous bedside monitoring and clinical assessment are critical in preventing limb ischemia for patients with DPC placement.