静脉-动脉体外膜氧合置入7 F血管鞘行下肢远端灌注治疗下肢缺血的效果及其预后的影响因素

Effect of veno-arterial extracorporeal membrane oxygenation implantation of 7 F vascular sheath for distal lower extremity perfusion in the treatment of lower extremity ischemia and its prognostic factors

目的探讨静脉-动脉体外膜氧合(V-A ECMO)置入7 F血管鞘行下肢远端灌注治疗下肢缺血的效果及其预后的影响因素。方法收集2019年6月至2021年6月于自贡市第四人民医院就诊的20例经股静脉-动脉(V-A)插管建立ECMO并置入7 F血管鞘行下肢远端灌注患者的临床资料,根据治疗效果的不同将其分为缓解组(n=8)与未缓解组(n=12),随访6个月后根据患者预后情况分为生存组(n=13)和死亡组(n=7),分析影响下肢缺血发生情况及预后情况的因素。结果治疗6 h,未缓解组患者血流量、血流速度均高于本组治疗前及缓解组患者,差异均有统计学意义(P﹤0.05)。治疗6 h,两组患者脑利钠肽(BNP)均高于本组治疗前,肌红蛋白(MYO)、肌酸激酶(CK)水平均低于本组治疗前,未缓解组患者MYO、CK水平均高于缓解组患者,差异均有统计学意义(P﹤0.05);多因素分析结果显示,治疗6 h的MYO水平、CK水平、血流量、血流速度均不是患者发生下肢缺血的影响因素(P﹥0.05)。缓解组与未缓解组患者并发症总发生率比较,差异有统计学意义(P=0.017)。生存组与死亡组患者的性别、治疗6 h BNP水平、治疗前及治疗6 h MYO水平、体重指数(BMI)比较,差异均有统计学意义(P﹤0.05);多因素分析结果显示,治疗6 h的BNP水平是影响患者预后情况的影响因素(P﹤0.05)。结论V-A ECMO置入7 F血管鞘行下肢远端灌注可有效缓解下肢缺血症状,但治疗效果受多种因素影响,需综合干预,治疗6 h后的BNP水平对患者预后影响较大,可作为V-A ECMO置入7 F血管鞘行下肢远端灌注患者预后预测的重要指标。

Objective To investigate the effect of veno-arterial extracorporeal membrane oxygenation(V-A ECMO)implantation of 7 F vascular sheath for distal lower extremity perfusion in the treatment of lower extremity ischemia and its prognostic factors.Method The clinical data of 20 patients with 7 F vascular sheath for distal lower extremity perfusion in the treatment of lower extremity ischemia in the Zigong Fourth People's Hospital from June 2019 to June 2021 were collected,they were divided into remission group(n=8)and non remission group(n=12)according to the treatment effect.After 6 months of follow-up,they were divided into survival group(n=13)and death group(n=7)according to the prognosis of the patients,the factors that affect the occurrence and prognosis of lower extremity ischemia were analyzed.Result After 6 hours of treatment,the blood flow and blood flow velocity of the unrelieved group were higher than those before treatment and the remission group,with statistical significance(P<0.05).After 6 hours of treatment,brain natriuretic peptide(BNP)of patients in both groups was higher than that before treatment,myoglobin(MYO)and creatine kinase(CK)were lower than that before treatment,the MYO and CK levels of patients in non remission group were higher than those in remission group,with statistical significance(P<0.05);the results of multivariate analysis showed that MYO,CK,blood flow volume,and blood flow velocity after 6 hours of treatment were not the influencing factors for lower extremity ischemia in patients(P>0.05).There was statistically significant difference in the total incidence of complications between the remission group and the unrelieved group(P=0.017).There were statistically significant differences in gender,6-hour BNP,pre-treatment and 6-hour MYO,and body mass index(BMI)between the survival and death groups(P<0.05),the results of multivariate analysis showed that BNP after 6 hours of treatment was a significant factor affecting the prognosis of patients(P<0.05).Conclusion V-A ECMO implantation of 7 F vascular sheath for lower extremity distal perfusion can effectively alleviate lower extremity ischemia,but the therapeutic effect is affected by many factors,which requires comprehensive intervention.BNP after 6 hours of treatment has a greater impact on the prognosis of patients,which can be used as an important index for predicting the prognosis of patients with vein artery extracorporeal membrane oxygenation implantation of 7F vascular sheath for lower extremity distal perfusion.