右心声学造影在静脉-静脉体外膜肺氧合插管中的应用  

Application of right heart contrast echocardiography in cannulation of veno-venous extracorporeal membrane oxygenation

作　　者：刘少中[1] 刘晓真[1] 叶木奇[1] 文鼎华[1] 黄泳航[1] LIU Shaozhong;LIU Xiaozhen;YE Muqi;WEN Dinghua;HUANG Yonghang(Department of Ultrasonography,Zhongshan People's Hospital,Zhongshan 528403,China)

机构地区：[1]中山市人民医院超声影像科,广东中山528403

出　　处：《中国医学影像技术》2020年第5期754-757,共4页Chinese Journal of Medical Imaging Technology

摘　　要：目的观察右心声学造影在静脉-静脉体外膜肺氧合(V-V ECMO)插管中的应用价值。方法收集18例接受经右股静脉及右颈内静脉插管V-V ECMO治疗的重症肺炎致急性呼吸衰竭患者,根据插管时是否行右心声学造影分为造影组(n=8)和对照组(n=10),测量并记录其中心静脉压(CVP)及心输出量(CO)。运转ECMO后,对造影组患者行心血管常规超声检查及右心声学造影,观察并调整下腔静脉内套管尖端位置;对照组患者仅行心血管常规超声,观察下腔静脉瓣处血流方向及下腔静脉内套管尖端位置。测量并记录2组患者下腔静脉内套管尖端与膈肌的距离(DCTD)及左股动脉氧分压,比较组间DCTD、左股动脉氧分压、CVP及CO差异。结果造影组DCTD[5.14(4.68,5.81)mm]和左股动脉氧分压[90.05(85.06,95.33)mmHg]均高于对照组[3.31(2.96,3.69)mm、78.61(71.82,81.04)mmHg,Z=-1.93、-2.20,P均<0.05];组间CVP和CO差异无统计学意义(Z=-1.79,-1.80,P均>0.05)。结论右心声学造影有助于V-V ECMO插管时调整下腔静脉内套管尖端位置,减少再循环,提高临床治疗效果。Objective To observe the application value of right heart contrast echocardiography in the cannulation of veno-venous extracorporeal membrane oxygenation(V-V ECMO).Methods A total of 18 patients with acute respiratory failure caused by severe pneumonia who underwent V-V ECMO treatment were enrolled.The patients were intubated through right femoral vein and right internal jugular vein cannulation,and then were divided into contrast group(n=8)and control group(n=10)according to whether underwent right heart contrast echocardiography during intubation or not.Central venous pressure(CVP)and cardiac output(CO)of all patients were measured and recorded.After the operation of ECMO,patients in contrast group received cardiovascular routine ultrasound examination and right heart contrast echocardiography simultaneously to observe and adjust the position of the cannula tip in the inferior vena cava(IVC),while patients in control group received only cardiovascular routine ultrasound to observe the direction of blood flow at the valve of IVC and the position of cannula tip in IVC.The distance between cannula tip and diaphragm(DCTD)and the left femoral artery partial pressure were measured and recorded.The differences of DCTD,left femoral artery oxygen partial pressure,CVP and CO of 2 groups were compared between 2 groups.Results DCTD(5.14[4.68,5.81]mm)and left femoral artery oxygen partial pressure in contrast group(90.05[85.06,95.33]mmHg)were both higher than those in control group(3.31[2.96,3.69]mm,78.61[71.82,81.04]mmHg,Z=-1.93,-2.20,both P<0.05).No significant difference of CVP nor CO was found between 2 groups(Z=-1.79,-1.80,both P>0.05).Conclusion Right heart contrast echocardiography can help to optimize the position of cannula tip in IVC during intubation of V-V ECMO and improve clinical therapeutic effect by reducing recirculation.

关 键 词：急性呼吸衰竭 超声心动描记术 体外膜氧合作用 

分 类 号：R563.8[医药卫生—呼吸系统] R445.1[医药卫生—内科学]