经皮血氧监测及远端灌注管在静脉-动脉体外膜肺氧合急性肢体缺血并发症中的应用价值  

Application value of transcutaneous oximeter and distal perfusion catheter in acute limb ischemia in patients with venoarterial extracorporeal membrane oxygenation

作　　者：路坤 朱森燚 陈真真 吴强 汪华学 LU Kun;ZHU Senyi;CHEN Zhenzhen;WU Qiang;WANG Huaxue(Department of Intensive Care Unit,The First Affiliated Hospital of Bengbu Medical University,Bengbu Anhui 233004,China)

机构地区：[1]蚌埠医科大学第一附属医院重症医学科,安徽蚌埠233004

出　　处：《蚌埠医学院学报》2024年第2期162-166,171,共6页Journal of Bengbu Medical College

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

摘　　要：目的:探讨经皮血氧监测及远端灌注管(DPC)在静脉-动脉体外膜肺氧合(VA-ECMO)急性肢体缺血(ALI)并发症中的应用价值。方法:选择接受VA-ECMO治疗的50例病人作为研究对象,所有病人均采用超声引导下外周股动静脉置管,并留置DPC。根据有无发生ALI,分为缺血组(n=15)和未缺血组(n=35)。使用经皮血氧仪监测动脉插管侧下肢经皮氧分压(PtcO_(2))和经皮二氧化碳分压(PtcCO_(2)),并进行氧负荷试验(OCT)。比较2组病人一般临床资料、OCT前后PtcO_(2)和PtcCO_(2)、10 min-OCT、DPC接入前后PtcO_(2)和PtcCO_(2)的差异,并利用受试者工作曲线(ROC曲线)评估其对ALI发生的预测价值。结果:未缺血组病人在OCT后PtcO_(2)明显升高,2组病人在OCT后PtcO_(2)、10 min-OCT比较差异均有统计学意义(P<0.01),缺血组病人在OCT后PtcO_(2)、PtcCO_(2)无明显变化(P>0.05);2组病人在DPC接入前PtcO_(2)和PtcCO_(2)比较差异均有统计学意义(P<0.01),但缺血组病人在DPC接入后PtcO_(2)明显升高、PtcCO_(2)明显降低,2组病人在DPC接入后PtcO_(2)和PtcCO_(2)比较差异均无统计学意义(P>0.05);ROC曲线分析显示,10 min-OCT、OCT后PtcO_(2)、DPC接入前PtcO_(2)和PtcCO_(2)对ALI的发生具有较好的预测价值,ROC曲线下面积分别为0.945(95%CI:0.934~1.000)、0.904(95%CI:0.821~0.987)、0.939(95%CI:0.870~1.000)、0.874(95%CI:0.766~0.983),且两两比较差异均无统计学意义(P>0.05)。结论:经皮血氧监测可以作为VA-ECMO病人并发ALI的有效监测手段,通过OCT可以更早地识别出ALI的发生。DPC可以明显改善VA-ECMO病人的下肢血供,建议在VA-ECMO置管时常规放置。Objective:To investigate the application value of transcutaneous oximeter and distal perfusion catheter(DPC)in acute limb ischemia(ALI)complications of venoarterial extracorporeal membrane oxygenation(VA-ECMO).Methods:A total of 50 patients who received VA-ECMO treatment were selected as the study subjects.All patients were treated with ultrasound-guided peripheral femoral arteriovenous catheter and indwelling DPC.The patients were divided into ischemia group(n=15)and non-ischemia group(n=35)according to the occurrence of ALI.Transcutaneous oxygen pressure(PtcO_(2))and transcutaneous carbon dioxide pressure(PtcCO_(2))of lower extremity on the side of arterial catheterization were monitored,and oxygen challenge test(OCT)was performed.The general clinical data,PtcO_(2) and PtcCO_(2) before and after OCT,10 min-OCT,and PtcO_(2) and PtcCO_(2) before and after DPC access were compared between the two groups.The predictive value of PtcO_(2) and PtcCO_(2) was evaluated by receiver operating characteristic(ROC)curve.Results:PtcO_(2) was significantly increased after OCT in patients without ischemia,resulting in statistically significant differences in PtcO2 and 10 min-OCT between the two groups(P<0.01),while there were no significant changes in PtcO_(2) and PtcCO_(2) after OCT in patients with ischemia(P>0.05).There were statistically significant differences in PtcO_(2) and PtcCO_(2) between the two groups before DPC access(P<0.01),but PtcO_(2) was significantly increased and PtcCO_(2) was significantly decreased in the ischemic group after DPC access,resulting in no statistically significant difference between PtcO_(2) and PtcCO_(2) between the two groups after DPC access(P>0.05).ROC curve analysis showed that 10 min-OCT,PtcO_(2) after OCT,PtcO_(2) and PtcCO_(2) before DPC access had good predictive value on the occurrence of ALI,and the area under ROC curve was 0.945(95%CI:0.934-1.000),0.904(95%CI:0.821-0.987),0.939(95%CI:0.870-1.000),0.874(95%CI:0.766-0.983),and pairwise comparison of the ROC curves of the above four

关 键 词：体外膜肺氧合 急性肢体缺血 经皮氧分压 经皮二氧化碳分压 氧负荷试验 远端灌注管 

分 类 号：R544.2[医药卫生—心血管疾病]