经皮置管静脉-动脉体外膜氧合支持撤机后血管事件发生情况及相关因素分析

Vascular Events and Related Factors of Percutaneous Veno-Arterial Extracorporeal Membrane Oxygenation After Withdrawal

目的分析经皮置管静脉-动脉体外膜氧合支持(V-A ECMO)撤机后的血管事件和发生的临床相关因素。方法回顾性分析郑州大学第二附属医院重症医学科77例成功撤机的V-A ECMO患者。将发生血管事件患者纳入病例组,未发生患者纳入对照组。比较两组患者临床资料,采用多因素分析logistic回归分析V-A ECMO撤机后血管事件的危险因素。结果2015—2023年,共有124例患者成功撤机,其中77例患者被纳入本研究。15例(15/77,19.48%)发生导管相关性深静脉血栓(CaDVT);7例出现动脉血管并发症(9/77,9.09%),其中3例为下肢动脉闭塞,涉及双侧胫前动脉、双侧胫后动脉远端和足背动脉节段,2例为股动脉血栓,均接受了动脉取栓术,2例为股动脉瘤。年龄≥60岁、ECMO前6 h序贯性器官功能衰竭(SOFA)评分、ECMO运行时间、ECMO撤机后感染与血管并发症相关。结论V-A ECMO患者撤机后的血管并发症主要表现为深静脉血栓和动脉并发症。年龄≥60岁、ECMO运行时间和ECMO撤机后感染是撤机后发生血管事件的独立危险因素。

Objective To analyze the vascular events and clinical related factors after the successfully removal of percutaneous veno-arterial extracorporeal membrane oxygenation(V-A ECMO).Methods A total of 77 V-A ECMO patients who were evacuated from the Second Affiliated Hospital of Zhengzhou University were retrospectively analyzed.Patients who had experienced vascular events were included in the case group,while those who had not were included in the control group.The clinical data of the two groups were compared,and the risk factors of vascular events after V-A ECMO withdrawal were analyzed by multivariate logistic regression analysis.Results A total of 124 patients were successfully withdrawn from 2015 to 2023,of which 77 patients were included in this study.Fifteen patients(15/77,19.48%)developed catheter-associated deep vein thrombosis(CaDVT).There were 7 cases of arterial vascular complications(9/77,9.09%).Among them,3 cases were lower extremity artery occlusion,involving bilateral anterior tibial artery,bilateral distal tibial artery and dorsal pedis artery segment,there were also 2 cases with femoral artery thrombosis,all of which received arterial thrombectomy,the other 2 cases were femoral aneurysms.Age greater than or equal to 60 years,pre-ECMO 6 hours sequential organ failure assessment(SOFA)score,ECMO run time,and post-ECMO infection were associated with vascular complications.Conclusion The main vascular complications in V-A ECMO patients after withdrawal were deep vein thrombosis and arterial thrombosis.Age≥60 years old,ECMO running time and infection after ECMO withdrawal were independent risk factors for vascular events after ECMO withdrawal.