下肢灌注评分对VA-ECMO治疗患者下肢缺血的诊断价值分析

Diagnostic value of lower extremity perfusion score for lower extremity ischemia in patients with VA-ECMO treatment

目的 探讨下肢灌注评分对静脉-动脉体外膜肺氧合(VA-ECMO)治疗患者下肢缺血诊断价值。方法 选取2017年1月至2021年6月金华市中心医院收治的行VA-ECMO治疗的患者101例。根据VA-ECMO治疗后患者是否出现下肢缺血的临床症状(下肢皮肤苍白、足背动脉未扪及、皮肤温度降低)分为未缺血组80例和缺血组21例。患者在VA-ECMO治疗期间根据下肢灌注评分表每日进行下肢灌注动态评估,包括患者毛细血管充盈实验(CRT)、经皮氧分压(tcPO2)、彩色多普勒超声检查(CDU)、脉搏血氧饱和度(SpO2)。比较两组患者性别、年龄、BMI、急性生理学与慢性健康状况Ⅱ评分(APACHEⅡ)等一般资料。比较两组ECMO插管位置、管路型号。比较两组患者下肢灌注评分。分析下肢灌注评分对下肢缺血的诊断效能。结果两组患者性别、年龄、BMI、APACHEⅡ评分等一般资料比较差异均无统计学意义(均P>0.05)。两组患者VA-ECMO插管位置、管路型号比较差异均无统计学意义(均P>0.05)。未缺血组患者CRT评分、tcPO2评分、CDU评分及下肢灌注总评分均明显低于缺血组,差异均有统计学意义(均P<0.05),而两组患者SpO2评分比较差异无统计学意义(P>0.05)。ROC曲线分析显示,CRT评分、tcPO2评分、CDU评分及下肢灌注总评分的AUC分别为0.768、0.651、0.698、0.926,下肢灌注总评分的灵敏度和特异度最高,分别为0.900、0.775,差异均有统计学意义(均P<0.05)。结论 VA-ECMO治疗期间,患者通过下肢灌注评分表动态监测有助于下肢缺血的早期诊断、治疗。

Objective To evaluate the application of the lower extremity perfusion score in the diagnosis of lower extremity ischemia in patients treated with veno-arterial extracorporeal membrane oxygenation(VA-ECMO). Methods A total of 101 patients who received VA-ECMO treatment in Jinhua Central Hospital from January 2017 to June 2021 were enrolled. According to the clinical symptoms of lower limb ischemia(pallor, no pulse, decreased skin temperature) after VAECMO treatment, the patients were divided into the non-ischemia group(80 cases) and the ischemia group(21 cases).During VA-ECMO treatment, patients were assessed for lower extremity perfusion daily, including capillary refill test(CRT),transcutaneous arterial oxygen pressure(tcPO2), and color Doppler uitrasonography(CDU), and pulse oxygen saturation(SpO2). The sex, age, body mass index(BMI), acute physiology and chronic health evaluation Ⅱ score(APACHEⅡ), ECMO intubation position and pipeline type, and lower limb perfusion scores were compared between the two groups. The diagnostic efficacy of lower limb perfusion score for lower limb ischemia was evaluated with ROC curve. Results There were no significant differences in gender, age, BMI, APACHE Ⅱ, the ECMO intubation position and tube type between the two groups. The CRT score, tcPO2score, CDU score and total score of patients in non-ischemia group were significantly lower than those in ischemia group(P<0.05). The areas under the ROC curve(AUC) of the CRT score, tcPO2 score, CDU score and total score for diagnosing lower extremity ischemia were 0.768, 0.651, 0.698, and 0.926, respectively. The sensitivity and specificity of the total score were higher than other parameters(P<0.05). Conclusion Dynamic monitoring of lower extremity perfusion assessment scale in VA-ECMO patients is helpful for early diagnosis and treatment of lower extremity avascular necrosis.