经皮穿刺预缝合技术在体外膜肺氧合快速建立血管通路中的应用  

Curative effect on percutaneous pre-suture technique in rapid establishment of vascular access for extracorporeal membrane oxygenation

作　　者：冯钢[1] 许志锋[1] 韩振[1] 吴永前[1] 任明明[1] 欧阳春[1] 叶小强 黄磊[1] 温远祥 FENG Gang;XU Zhi-feng;HAN Zhen;WU Yong-qian;REN Ming-ming;OUYANG Chun;YE Xiao-qiang;HUANG Lei;WEN Yuan-xiang.(Department of Cardiovascular Surgery, Shenzhen Hospital of Peking University, Shenzhen 518036, Guangdong, CHINA)

机构地区：[1]北京大学深圳医院心血管外科,广东深圳518036

出　　处：《海南医学》2018年第10期1455-1457,共3页Hainan Medical Journal

基　　金：广东省深圳市科技计划项目(编号:JCYJ20150403091443327)

摘　　要：目的探讨经皮穿刺预缝合技术在体外膜肺氧合(ECMO)快速建立血管通路中的有效性及安全性。方法回顾分析北京大学深圳医院2015年1月至2017年7月经皮穿刺置管并应用Proglide血管缝合器行动脉预缝合建立血管通路行ECMO支持的12例患者的临床资料,观察经皮穿刺置管成功率、置管时间、切口出血、切口感染、远端肢体缺血情况以及拔管后穿刺口出血情况。结果经皮穿刺股动静脉置管成功率为100%,平均置管时间为(8.2±2.7)min,切口出血发生率为0(0/12),切口感染发生率为0(0/12),下肢缺血发生率为8.3%(1/12),拔管后穿刺口出血率为0(0/12)。结论经皮穿刺可以快速建立血管通路,可以有效避免切口出血、感染以及避免远端肢体缺血,动脉预缝合技术可以保证拔管后穿刺口的安全止血,经皮穿刺预缝合技术在体外膜肺氧合快速建立血管通路应用安全有效。Objective To evaluate the efficacy and safety of percutaneous pre-suture technique in the rapid establishment of vascular access for extracorporeal membrane oxygenation（ECMO）. Methods The clinical data of 12 patients supported by ECMO whose vascular access were established by percutaneous technique and pre-suture by ProGlide vessel suture instrument from January 2015 to July 2017 in Shenzhen Hospital of Peking University were analyzed retrospectively. The rate of successful catheterization, the consuming time of catheterization, the rate of incision bleeding, the incidence of incision infection, the situation of distal limb ischemia and the bleeding rate after extubation were observed. Results The rate of success catheterization was 100% and the average catheter consuming time was（8.2 ±2.7） minutes. The rate of incision bleeding was 0（0/12）, and wound infection was 0（0/12）. The incidence of ischemia in distal limb was 8.3%（1/12）, and puncture bleeding after extubation was 0（0/12）. Conclusion Vascular access can be rapidly established by using the technique of percutaneous puncture, which can effectively prevent bleeding and infection of the surgical incision, and avoid ischemia in the distal limb. The technique of arterial pre-suture can ensure the safe hemostasis of the puncture port after extubation. The percutaneous pre-suture technique is safe and effective in the rapid establishment of vascular access for ECMO.

关 键 词：经皮穿刺置管 血管预缝合 血管通路建立 体外膜肺氧合 

分 类 号：R654.3[医药卫生—外科学]