心脏超声指导静动脉体外膜肺氧合流量管理的应用效果  

Application Effect of Cardiac Ultrasound on Extracorporeal Membrane Oxygenation Flow Management

作　　者：李小芳[1] 程国栋[1] 朱春磊[1] 陈乃颖 LI Xiao-fang;CHENG Guo-dong;ZHU Chun-lei;CHEN Nai-ying(No.1 Critical Care Unit of Gaozhou People􀆳s Hospital,Maoming City,Guangdong Province,525200)

机构地区：[1]广东省茂名市高州市人民医院重症一区,525200

出　　处：《岭南急诊医学杂志》2022年第5期406-408,423,共4页Lingnan Journal of Emergency Medicine

基　　金：广东省茂名市科技项目(2019037)。

摘　　要：目的:探讨采取心脏超声指导管理静动脉体外膜肺氧合(V⁃A ECMO)流量的应用效果。方法:选取2020年1月至2021年12月在高州市人民医院重症一区因左心功能衰竭行V⁃AECMO辅助的患者48例,将患者随机分为2组,A组为心脏超声指导流量管理组,B组为经验管理流量组。A组应用心脏超声技术测算左室流出道速度时间积分,并计算自身心输出量(Cardiac Output,CO),根据自身CO调节ECMO流量,滴定至自身CO达到最大化,同时使全身血流量≥2.4 L/min/m2×BSA(体表面积)以满足机体基本灌注量。B组依据平均动脉压、乳酸、尿量、ScvO2、血管活性药物剂量等指标调整流量。比较2组患者ECMO使用时间、机械通气时间、撤机成功率、并发症发生率、ICU住院时间及30天存活率。结果:A组患者ECMO辅助时间、机械通气时间明显少于B组[92.0(57.5,106.8)h vs 144.3(73.4,166.8)h,P<0.05]、[107.7(60.3,124.7)h vs 137.9(68.0,178.3)h,P<0.05]。A组ECMO撤机成功率明显高于B组(68.00%vs 52.17%,P<0.05),并发症发生率明显低于B组(48.0%vs 69.57%,P<0.05)。结论:通过心脏超声指导ECMO流量进行滴定式管理,可以减少ECMO使用时间,降低并发症发生率,提高撤机成功率及30天存活率。Objective:To explore the application effect of cardiac ultrasound to manage the flow of extracorporeal membrane oxygenation(V-A ECMO). Methods:From January 2020 to December 2021,48 patients who received V-A ECMO assistance due to left heart failure in the first critical area of Gaozhou People ’ s Hospital were selected and randomly divided into two groups: group A was the ECMO flow management group guided by transthoracic echocardiography,and group B was the experience management flow group. In group A,the left ventricular outflow tract velocity time integral(VTi)was measured by cardiac ultrasound,and the cardiac output(CO)was calculated. The ECMO flow was adjusted according to its CO,titrated to maximize its CO,and the whole body blood flow was≥2.4 L/min/m2×BSA(body surface area)to meet the basic perfusion volume of the body. In group B,the flow was adjusted according to the average arterial pressure,lactic acid,urine volume,ScvO2,vasoactive drug dose and other indicators.The ECMO use time,mechanical ventilation time,weaning success rate,complication rate,ICU hospitalization time and 30 day survival rate were compared between the two groups. Results:The time of ECMO assistance and mechanical ventilation in group A was significantly shorter than that in group B[92.0(57.5106.8)h vs 144.3(73.4166.8)h,P<0.05],[107.7(60.3124.7)h vs 137.9(68.0178.3)h,P<0.05]. The successful rate of ECMO weaning in group A was significantly higher than that in group B(68.00% vs 52.17%,P<0.05),and the incidence of complications was significantly lower than that in group B(48.0% vs 69.57%,P<0.05). Conclusion:Titration management of ECMO flow guided by cardiac ultrasound can reduce the use time of ECMO,edruce the incidence of complications,and improve the success rate of weaning and the 30 day survival rate.

关 键 词：心脏超声 静动脉体外膜肺氧合 左室流出道速度时间积分 心输出量 

分 类 号：R459.7[医药卫生—急诊医学]