改良置管方式在静脉动脉体外膜氧合中的应用  

Application of an improved intubation method in venoarterial extracorporeal membrane oxygenation

作　　者：路坤 赵士兵[1] 陈金梦 吴强[1] 汪华学[1] LU Kun;ZHAO Shibing;CHEN Jinmeng;WU Qiang;WANG Huaxue(Department of Critical Care Medicine,The First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004,China)

机构地区：[1]蚌埠医学院第一附属医院重症医学科,安徽蚌埠233004

出　　处：《安徽医药》2023年第10期2022-2026,I0005,共6页Anhui Medical and Pharmaceutical Journal

基　　金：安徽省临床重点专科建设项目(卫科教秘[2017]27号-10);蚌埠医学院自然科学重点项目(2021byzd154)。

摘　　要：目的探讨一种改良置管方式在静脉动脉体外膜氧合(VA-ECMO)中的应用价值。方法回顾性研究2020年3月至2022年3月蚌埠医学院第一附属医院重症医学科收治接受VA-ECMO治疗的42例病人临床资料,根据置管方式的不同,分为改良组18例和超声引导组24例,比较两组病人的基线资料、预后情况、ECMO建立时间、一次性动静脉置管成功率、远端灌注管(DPC)放置成功率、ECMO撤除时间以及相关并发症等指标的差异。结果改良组ECMO建立时间[(35.78±7.46)比(49.46±23.45)min]、ECMO撤除时间[(39.00±9.93)比(56.82±6.77)min]、置管总并发症发生率[16.67%(3/18)比50.00%(12/24)]均低于超声引导组(P<0.05);改良组一次性动脉置管成功率[100%(18/18)比66.67%(16/24)]、DPC放置成功率[100%(18/18)比70.83%(17/24)]均高于超声引导组(P<0.05);两组撤机成功率[50.00%(9/18)比45.83%(11/24)]、撤机后28 d存活率[44.44%(8/18)比33.33%(11/24)]、一次性静脉置管成功率[77.78%(14/18)比70.83%(17/24)]、置管血红蛋白下降[(2.28±1.90)比(3.17±2.62)g/L]、拔管总并发症发生率[22.22%(2/9)比27.27%(3/11)]、拔管血红蛋白下降[(2.33±1.50)g/L比(3.09±1.58)g/L]比较,均差异无统计学意义(P>0.05)。结论与超声引导下经皮穿刺置管比较,改良置管可以缩短VA-ECMO建立及撤除时间,具有一次性动脉置管成功率高,置管总并发症发生率低,且使DPC放置变得简单等优点。Objective To explore the application value of an improved intubation method in venous artery extracorporeal membrane oxygenation(VA-ECMO).Methods A retrospective study was conducted on the clinical data of 42 patients who received VA-ECMO treatment in the Intensive Care Unit of the First Affiliated Hospital of Bengbu Medical College from March 2020 to March 2022.The patients were divided into the improved group(n=18)and the ultrasound-guided group(n=24).The differences in baseline data,prognosis,ECMO establishment time,success rate of one-time arteriovenous catheterization,success rate of distal perfusion catheter(DPC)placement,ECMO removal time and related complications were compared between the two groups.Results In the improved group,ECMO establishment time[(35.78±7.46)min vs.(49.46±23.45)min]and ECMO removal time[(39.00±9.93)min vs.(56.82±)6.77)min]and the overall incidence of catheterization complications[16.67%(3/18)vs.50.00%(12/24)]were lower than those in the ultrasoundguided group(P<0.05).The success rate of one-time arterial catheterization[100%(18/18)vs.66.67%(16/24)]and the success rate of DPC placement[100%(18/18)vs.70.83%(17/24)]in the improved group were higher than those in the ultrasound-guided group(P<0.05).There were no significant differences in the success rate of ECMO removal[50.00%(9/18)vs.45.83%(11/24)],survival rate at 28 days after ECMO removal[44.44%(8/18)vs.33.33%(11/24)],success rate of one-time intravenous catheterization[77.78%(14/18)vs.70.83%(17/24)],decrease of hemoglobin before and after catheterization[(2.28±1.90)g/L vs.(3.17±2.62)g/L],total complication rate of extubation[22.22%(2/9)vs.27.27%(3/11)],decrease of hemoglobin before and after extubation[(2.33±1.50)g/L vs.(3.09±1.58)g/L]between the two groups(P>0.05).Conclusion Compared with ultrasound-guided percutaneous catheterization,the modified catheterization can shorten the establishment and removal time of VA-ECMO,and has the advantages of high success rate of one-time arterial catheterization,low incidence of total

关 键 词：导管 留置 氧合器 膜式 体外膜氧合 超声引导经皮穿刺置管 外科切开置管 

分 类 号：R459.7[医药卫生—急诊医学]