不同静脉插管在肺移植VA-ECMO辅助中的疗效比较  

Comparison of the efficacy of different venous intubation in venous-arterial extracorporeal membrane oxygenation assisted lung transplantation

作　　者：钱晓亮 陈月 魏立 贾向波 徐磊 唐富东 张加强 任培军 李建朝 杨雷一 程兆云 Qian Xiaoliang;Chen Yue;Wei Li;Jia Xiangbo;Xu Lei;Tang Fudong;Zhang Jiaqiang;Ren Peijun;Li Jianchao;Yang Leiyi;Cheng Zhaoyun(Department of Extracorporeal Circulation,People's Hospital of Henan Province,People's Hospital of Zhengzhou University,Fuwai Central China Cardiovascular Disease Hospital,Zhengzhou 450000,Henan,China;Department of Anesthesia,People's Hospital of Henan Province,People's Hospital of Zhengzhou University,Zhengzhou 450000,Henan,China;Department of Thoracic Surgery,People's Hospital of Henan Province,People's Hospital of Zhengzhou University,Zhengzhou 450000,Henan,China;Department of Cardiac Surgery,People's Hospital of Henan Province,People's Hospital of Zhengzhou University,Fuwai Central China Cardiovascular Disease Hospital,Zhengzhou 450000,Henan,China)

机构地区：[1]河南省人民医院,郑州大学人民医院,阜外华中心血管病医院体外循环科,郑州450000 [2]河南省人民医院,郑州大学人民医院麻醉科,郑州450000 [3]河南省人民医院,郑州大学人民医院胸外科,郑州450000 [4]河南省人民医院,郑州大学人民医院,阜外华中心血管病医院心血管外科,郑州450000

出　　处：《中华危重病急救医学》2021年第9期1080-1083,共4页Chinese Critical Care Medicine

基　　金：河南省医学科技攻关计划(联合共建)项目 (20190796)。

摘　　要：目的比较在肺移植手术中行静脉-动脉体外膜肺氧合(VA-ECMO)辅助过程中应用不同静脉插管引流对改善患者全身氧合状态疗效的差异。方法选择河南省人民医院2016年12月至2019年12月行单肺移植术中应用VA-ECMO辅助的12例患者为研究对象。根据所使用静脉插管侧孔的多少分为少侧孔静脉插管组和多侧孔静脉插管组,每组6例。比较两组患者辅助前后右侧桡动脉、左侧桡动脉、右颈内静脉血气指标的差异,评价辅助效果。结果两组患者右侧和左侧桡动脉辅助后动脉血氧分压(PaO2)均较辅助前明显升高〔mmHg(1 mmHg=0.133 kPa):少侧孔静脉插管组右侧桡动脉为79.5±4.2比48.3±3.8,左侧桡动脉为88.1±3.5比48.3±3.8;多侧孔静脉插管组右侧桡动脉为67.7±5.9比48.7±3.2,左侧桡动脉为84.0±3.8比48.7±3.2,均P<0.05〕,动脉血二氧化碳分压(PaCO2)均较辅助前明显降低(mmHg:少侧孔静脉插管组右侧桡动脉为44.2±2.6比71.7±4.4,左侧桡动脉为44.7±1.4比71.7±4.4;多侧孔静脉插管组右侧桡动脉为46.2±2.1比71.2±3.5,左侧桡动脉为44.1±1.9比71.2±3.5,均P<0.05)。少侧孔静脉插管组患者辅助后ECMO系统静脉引流管处血气分析指标静脉血氧分压(PvO2)明显低于多侧孔静脉插管组(mmHg:56.4±3.2比88.7±1.5,P<0.01),静脉血二氧化碳分压(PvCO2)明显高于多侧孔静脉插管组(mmHg:63.6±3.7比44.2±1.7,P<0.01)。结论在肺移植手术行VA-ECMO辅助时,通过使用少侧孔的静脉插管充分引流上腔血流,能更有效地改善肺移植患者上半身氧合情况,避免了上半身低氧合、下半身高氧合的窘境,可为单肺移植患者进行更加有效的辅助,对改善患者全身的氧合状态更有意义。Objective To compare the curative effects of different venous cannulas and drainage to improve patient's whole body oxygenation during the auxiliary process of venous-arterial extracorporeal membrane oxygenation(VA-ECMO)in lung transplantation.Methods From December 2016 to December 2019,12 patients who were assisted by VA-ECMO in one lung transplantation in People's Hospital of Henan Province were selected as the research objects.According to the number of side holes of venous cannulas,they were divided into two groups:one group with few side holes and other group with multiple side holes.The differences in blood gas indexes among the right radial artery,left radial artery,and right internal jugular vein before and after assistance were compared,and the assistance effect was evaluated.Results The arterial partial pressure of oxygen(PaO2)of blood gas indexes of the right and left radial arteries in both groups were significantly higher than that before assistance[mmHg(1 mmHg=0.133 kPa):right and left radial artery in few side holes group:79.5±4.2 vs.48.3±3.8 and 88.1±3.5 vs.48.3±3.8;right and left radial artery in multiple side holes group:67.7±5.9 vs.48.7±3.2 and 84.0±3.8 vs.48.7±3.2,all P<0.05].The arterial partial pressure of carbon dioxide(PaCO2)of blood gas index was significantly lower than that before assistance(mmHg:44.2±2.6 vs.71.7±4.4 for the right radial artery and 44.7±1.4 vs.71.7±4.4 for the left radial artery in the group with few side holes;46.2±2.1 vs.71.2±3.5 for the right radial artery and 44.1±1.9 vs.71.2±3.5 for the left radial artery in the group with multiple side holes,all P<0.05).The partial pressure of oxygen in venous blood(PvO2)of blood gas index of ECMO system in the group with few side holes was significantly lower than that of the multiport side holes group(mmHg:56.4±3.2 vs.88.7±1.5,P<0.01),and the partial pressure of carbon dioxide in venous blood(PvCO2)was significantly higher than that of multiport side holes group(mmHg:63.6±3.7 vs.44.2±1.7,P<0.01).Conclusions W

关 键 词：单肺移植 体外膜肺氧合 静脉插管 血气分析 

分 类 号：R655.3[医药卫生—外科学]