体外膜肺氧合支持期间合并下腔静脉血栓1例

One case of combined inferior vena cava thrombosis during ECMO support

体外膜肺氧合(ECMO)是一种行之有效的心肺支持手段,可为常规治疗无法逆转的危重患者提供临时的心肺支持。患者因暴发性心肌炎入住滨州医学院附属医院重症医学科,因存在血流动力学紊乱且符合ECMO支持指征,给予静脉-动脉体外膜肺氧合(VA-ECMO)支持治疗。撤除ECMO引流管后发现下腔静脉血栓形成,经多学科会诊,治疗上在充分抗凝及放置下腔静脉滤器后,给予尿激酶溶栓治疗,4 d后患者下腔静脉血栓消失。ECMO辅助下下腔静脉血栓并不多见,多经抗凝治疗后逐渐消失。该例患者在放置下腔静脉滤器后果断给予溶栓药物尿激酶静脉治疗,短期内复查血栓消失,提高了治疗效率。

Extracorporeal membrane oxygenation(ECMO)is an effective cardiopulmonary support method,which can provide temporary cardiopulmonary support for critical patients who cannot be reversed by conventional therapy.In this case,the patient was admitted to the Intensive Care Unit of Binzhou Medical University Hospital due to fulminant myocarditis and was given venous-arterial extracorporeal membrane oxygenation(VA-ECMO)support treatment due to hemodynamic disorders and compliance with ECMO support indications.Inferior vena cava thrombosis(IVCT)occurred after ECMO drainage tube removal.According to multidisciplinary consultation,the patient underwent thrombolytic therapy with urokinase after adequate anticoagulant and inferior vena cava filter placement.The IVCT disappeared four days later.IVCT events during ECMO adjuvant treatment are rare,most of which will gradually disappear after anticoagulant treatment.After the inferior vena cava filter was placed,intravenous treatment with thrombolytic drug urokinase was decisively given to this patient,which leads to thrombus disappearance in a short time confirmed by reexamination,thus improving the treatment efficiency.