体外膜氧合辅助心肺复苏患者50例置管经验总结  

Cannulation strategies of extracorporeal cardiopulmonary resuscitation in fifty patients

作　　者：苏用鹏 卢剑海 朱瑞秋 左六二 Su Yongpeng;Lu Jianhai;Zhu Ruiqiu;Zuo Liuer(Department of Critical Care Medicine,Shunde Hospital of Southern Medical University,Foshan 528300,China)

机构地区：[1]南方医科大学顺德医院(佛山市顺德区第一人民医院)重症医学科,佛山528300

出　　处：《中国体外循环杂志》2020年第2期95-97,共3页Chinese Journal of Extracorporeal Circulation

基　　金：佛山市医学类科技攻关项目(2016AB003583)。

摘　　要：目的对本院50例体外心肺复苏术(ECPR)患者体外膜氧合(ECMO)置管方式进行总结,为置管方式的选择提供经验。方法回顾性分析2013年5月至2019年6月期间南方医科大学顺德医院重症医学科经ECPR治疗难治性心脏骤停患者的置管相关的资料。比较切开置管与经皮穿刺置管两种方式的置管时间、成功率与并发症。结果50例实施ECPR支持的患者中,切开组15例,穿刺组35例。两组的主要基础疾病均为急性心肌梗死。建立ECMO主要地点:切开组为急诊科,穿刺组为重症医学科。切开置管组置管成功率为100%;穿刺置管组成功率77.1%,其中8例患者需要中转切开置管(t=4.082,P=0.043)。彩超引导下经皮穿刺置管组置管时间为(41.1±27.4)min,切开置管时间为(32.8±9.7)min,两组无统计学差异(t=-1.124,P=0.267)。并发症:切开置管部位大出血1例,需要再次外科手术止血。穿刺置管组出现置管部位感染1例,下肢缺血坏死3例。结论与穿刺置管比较,切开置管时间相似,但成功率更高,可能更适合在ECMO时建立血管通路。Objective This article reviewed the extracorporeal membrane oxygenation(ECMO)cannulation strategies of 50 pa tients with extracorporeal cardiopulmonary resuscitation(ECPR)in our hospital and aimed to provide appropriate strategies for different clinical scenarios of those critically ill patients.Methods We retrospectively analyzed the cannulation strategies of patients who re ceived ECPR treatment due to refractory cardiac arrest in our center from May 2013 to June 2019.The operatiopn time,success rate and complications of surgical and percutaneous cannulation were compared.Results Among the 50 patients received ECPR support,15 were in the surgical cannulation group and the other 35 were in the percutaneous cannulation group.The main underlying diseases in both groups were acute myocardial infarction.ECMO support was set up in the emergency department for the surgical cannulation group and in the critical medicine department for the percutaneous cannulation group.The success rate of the surgical cannulation group was 100%,while the success rate of the percutaneous cannulation group was 77.1%,in which 8 patients needed conversion to the surgical approach.The color Doppler-guided percutaneous cannulation time was(41.1±27.4)minutes and the surgical cannulation group time was(32.8±9.7)minutes.Complications included one case of massive hemorrhage at the incision site,who required reoperation.There were also 3 cases of lower limb ischemic necrosis and 1 case of infection in the puncture site.Conclusion Compared with percutaneous cannulation,surgical cannulation has a shorter operation time and a higher success rate,which could be more appropriate to establish vascular access during extracorporeal cardiopulmonary resuscitation.

关 键 词：体外膜氧合 体外心肺复苏术 经皮穿刺置管 切开置管 体外生命支持 急性心机梗死 

分 类 号：R459.7[医药卫生—急诊医学]