静脉-动脉体外膜肺氧合经胫后动脉逆行性远端灌注的临床效果分析

Clinical analysis of retrograde distal perfusion via posterior tibial artery in femoral veno-arterial extracorporeal membrane oxygenation

目的总结分析静脉-动脉体外膜肺氧合(V-A ECMO)经胫后动脉放置下肢灌注管(DPC)以逆行性远端灌注的方式与经验。方法回顾性分析2022年1月至2023年6月于本院接受V-A ECMO治疗并施行经胫后动脉放置DPC的15例患者的临床资料。结果15例患者V-A ECMO置管方式均为经皮穿刺置管,并均行手术切开经胫后动脉留置逆行性DPC:预防性置管6例,补救性置管9例,一次性置管成功率为93.33%,导管型号以6F鞘管为主(66.67%),预防性置管无ALI发生,补救性置管中发生1例骨筋膜室综合征,置管时间为(20.73±3.47)min。结论在V-A ECMO中,经胫后动脉放置DPC以逆行性远端灌注的方式是完全可行的,且具有较高的置管成功率,可预防或治疗下肢缺血。

Objective To summarize and analyze the modalities and experience of retrograde distal perfusion with distal perfusion catheter(DPC)via cannulation of the posterior tibial artery in veno-arterial extracorporeal membrane oxygenation(V-A ECMO).Methods The clinical data of 15 patients who were treated with V-A ECMO and underwent DPC placement via the posterior tibial artery in our hospital from January 2022 to June 2023 were retrospectively analyzed.Results The V-A ECMO catheterization method in 15 patients was percutaneous puncture catheterization,and all of them underwent surgical incision to indwelling retrograde DPC through the posterior tibial artery:6 cases of preventive catheterization,9 cases of remedial catheterization,the success rate of one-time catheterization was 93.33%,and the type of catheter was mainly 6 F sheath(66.67%).There was no ALI in preventive catheterization,and one case of osteofascial compartment syndrome occurred in remedial catheterization,and the catheterization time was 20.73±3.47 min.Conclusions In V-A ECMO,placement of DPC via the posterior tibial artery for retrograde distal perfusion is perfectly feasible,and has a high success rate,which can prevent or treat lower extremity ischemia.