低强度抗凝联合多指标监测在成人静脉-动脉体外膜氧合抗凝管理中的并发症分析  

Analysis of complications of low-intensity anticoagulation combined with multi-index monitoring in adult veno-arterial extracorporeal membrane oxygenation anticoagulation management

作　　者：熊鹰 魏新广 韩云飞 刘燕[2] Xiong Ying;Wei Xinguang;Han Yunfei;Liu Yan(Department of Medical College,Wuhan University of Science and Technology,Wuhan 430000,China)

机构地区：[1]武汉科技大学医学院,武汉430065 [2]武汉科技大学附属武汉亚洲心脏病医院体外循环科,武汉430022

出　　处：《中国体外循环杂志》2021年第3期150-154,192,共6页Chinese Journal of Extracorporeal Circulation

基　　金：武汉市卫生和计划生育委员会重点项目(WX18A01);湖北省自然科学基金面上项目(2018CFB779)。

摘　　要：目的分析比较危重症成人静脉-动脉体外膜氧合(V-A ECMO)在传统高强度与低强度抗凝模式下的并发症发生情况。方法回顾分析2011年5月至2020年10月本院符合研究纳入标准的113例使用V-A ECMO成人患者的临床资料,根据抗凝策略不同分为抗凝传统高强度组(n=53)和低强度组(n=60),分析患者在ECMO期间发生并发症的情况。结果低强度组转机平均时间为(103.92±96.67)h,高强度组平均时间为(72.38±70.81)h。低强度组和高强度组在出血(P=0.352)、血栓形成(P=0.240)、神经系统并发症(P=0.517)、肾功能损伤(P=0.782)、感染(P=0.954)、远端肢体缺血(P=0.954)、总并发症(P=0.795)及住院总死亡率(P=0.218)等并发症上均无统计学差异。其中出血并发症和住院总死亡率有减少的趋势[(37%vs.45%,P=0.352);(47%vs.53%,P=0.218)]。结论根据回顾性分析结果提示采用低强度抗凝方案在VA ECMO应用上是一种安全可靠的抗凝策略。Objective To analyze and compare the complications of veno-arterial extracorporeal membrane oxygenation(V-A ECMO)in critically ill adults undergoing traditional high-intensity or low-intensity anticoagulation modes.Methods The clinical data of 113 adult patients who met the inclusion criteria of V-A ECMO in our hospital from May 2011 to October 2020 were retrospectively analyzed.According to the different anticoagulation strategies,patients were divided into two groups:high intensity group(n=53)and low intensity group(n=60).The complications of patients during ECMO were analyzed.Results The average time of cardiopulmonary bypass was 103.92±96.67 h in low intensity group and 72.38±70.81 h in high intensity group.There was no significant difference between the two groups in bleeding(P=0.352),thrombosis(P=0.240),neurological complications(P=0.517),renal function injury(P=0.782),infection(P=0.954),distal limb ischemia(P=0.954),total complications(P=0.795)and total hospital mortality(P=0.218).Among them,bleeding complications and total hospital mortality had a decreasing trend.Conclusion Retrospective analysis indicated heart low intensity anticoagulant regimen was a safe and reliable anticoagulant strategy for V-A ECMO.

关 键 词：体外膜氧合 体外生命支持 危重症 成人 抗凝 并发症 

分 类 号：R459.7[医药卫生—急诊医学]