不同抗凝强度体外膜肺氧合治疗中的血管并发症  

Analysis of vascular complications in adults managed by the venous-arterial extracorporeal membrane oxygen with varying anticoagulant intensities

作　　者：范博 崔晓磊[1] 吕宝谱 刘亮[1] 郑拓康 张睿[1] 田英平[1] 高恒波[1] FAN Bo;CUI Xiaolei;LV Baopu(Department of Emergency,the Second Hospital of Hebei Medical University,Hebei,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院急诊科,石家庄市050000

出　　处：《河北医药》2023年第16期2416-2421,共6页Hebei Medical Journal

基　　金：河北省自然科学基金资助项目(编号:H2019206317)。

摘　　要：目的回顾分析静脉-动脉体外膜肺氧合治疗中不同抗凝强度下血管并发症、住院存活率以及输注血制品的情况。方法将2019年1月至2022年7月就诊的使用静脉-动脉体外膜肺氧合(venous-arterial extracorporeal membrane oxygenation,V-A ECMO)且运转时间>24 h的68例心肺衰竭的成人患者纳入本研究,以活化凝血时间(activated clotting time,ACT)进行分组,ACT基础值为140~180 s的患者列为低强度抗凝组,ACT基础值为180~220 s的患者列为高强度抗凝组,比较2组患者的血管并发症的发生率、住院存活率以及输血制品情况。结果共有37例病例纳入本研究标准,其中低强度抗凝组的患者共计22例,高强度抗凝组患者共计15例,低强度抗凝组的住院生存率明显高于高强度抗凝组(72.72%vs 33.33%),差异有统计学意义(P=0.042)。高强度抗凝组发生出血并发症的比例显著高于低强度抗凝组患者(53.33%vs 18.18%),差异有统计学意义(P=0.026)。并且高强度抗凝组中死亡原因由出血引起的占比显著高于低强度抗凝组(P=0.027)。2组患者在输血制品量比较中结果显示,高强度抗凝组患者所输入的悬浮红细胞的量要显著高于低强度抗凝组的患者,差异有统计学意义(P=0.044)。2组患者在各生化指标比较中结果显示,高强度抗凝组患者在第1天的APTT、第2天和第3天的INR、第二天的PT值显著高于低强度抗凝组患者,差异有统计学意义(P<0.05)。而第2天的Fib,则低强度抗凝组的患者要显著高于高强度抗凝组的患者(P=0.03)。结论低强度抗凝策略在V-A ECMO治疗中出血并发症少、住院生存率高,相对安全。Objective To retrospectively analyze the vascular complications,in-hospital survival,and transfusion of blood products in adults managed by the venous-arterial extracorporeal membrane oxygen(V-A ECMO)with varying anticoagulant intensities.Methods A total of 68 adult patients with cardiopulmonary failure managed by V-A ECMO for over 24 hours in the Emergency Department of the Second Hospital of Hebei Medical University from January 2019 to July 2022 were enrolled.Stratified by the activated clotting time(ACT),patients were divided into the low-intensity anticoagulation group(baseline ACT of 140-180s)and high-intensity anticoagulation group(baseline ACT of 180-220s).Vascular complications,in-hospital survival,and transfusion of blood products were compared between groups.Results A total of 37 eligible patients with cardiopulmonary failure were included,involving 22 patients in the low-intensity anticoagulation group and 15 in the high-intensity anticoagulation group.The in-hospital survival of patients in low-intensity anticoagulation group was significantly higher than that of high-intensity anticoagulation group(72.72%vs 33.33%,P=0.042).The incidence of bleeding complications(53.33%vs 18.18%,P=0.026)and the mortality due to bleeding(P=0.027)were significantly higher in the high-intensity anticoagulation group than those of low-intensity anticoagulation group.The transfusion amount of suspended red blood cells in the high-intensity anticoagulation group was significantly higher than that in the low-intensity anticoagulation group(P=0.044).The activated partial thromboplastin time(APTT)on the first day,international normalized ratio(INR)on the second and third day,and prothrombin time(PT)on the second and third day were significantly higher in the high-intensity anticoagulation group than those in low-intensity anticoagulation group(P<0.05).The fibrinogen(Fib)on the second day was significantly lower in the high-intensity anticoagulation group than that in low-intensity anticoagulation group(P=0.03).Conclusion The

关 键 词：体外膜肺氧合(ECMO) 血管并发症 住院存活率 抗凝 

分 类 号：R459.7[医药卫生—急诊医学]