密闭式快速管道预充法在体外心肺复苏患者中的应用  

Application of closed rapid pipeline prefilling method in patients with extracorporeal cardiopulmonary resuscitation

作　　者：高永霞 陈旭锋 王维惟 蔡金霞 黄红娟 郭媛 王薇 任尧 GAO Yongxia;CHEN Xufeng;WANG Weiwei;CAI Jinxia;HUANG Hongjuan;GUO Yuan;WANG Wei;REN Yao(Department of Emergency Medicine,Jiangsu Province Hospital,The First Af liated Hospital with Nanjing Medical University,Nanjing,Jiangsu 210029,China)

机构地区：[1]南京医科大学第一附属医院江苏省人民医院急诊监护病房,江苏南京210029

出　　处：《中国临床研究》2024年第10期1613-1617,共5页Chinese Journal of Clinical Research

基　　金：江苏省财政支持临床重点专科项目(JSYJY-2-2021-JZ38);江苏省人民医院“临床能力提升工程”项目(JSPH-NB-2020-10)。

摘　　要：目的探讨密闭式快速管道预充法在体外膜肺氧合(ECMO)辅助体外心肺复苏(ECPR)患者中的临床应用效果。方法回顾性纳入2018年1月至2021年12月江苏省人民医院急诊监护病房收治的心搏骤停且接受ECPR的患者作为研究对象,其中2018年1月至2019年6月采用常规ECMO管道预充法为常规预充组(n=36),2019年9月至2021年12月采用改良密闭式快速ECMO管道预充法为改良预充组(n=78)。分析两种预充方法对预充效果、患者结局和预充工作人员满意度的影响。结果改良预充组的1次预充成功率高于常规预充组(98.7%vs 77.8%,χ^(2)=12.110,P<0.01),预充时间短于常规预充组[(10.78±1.76)min vs(19.50±3.20)min,t=18.746,P<0.01]。两组的神经系统指标[血清神经特异性烯醇化酶(NSE)水平和格拉斯哥昏迷评分(GCS)]、自主循环恢复率和出院率差异无统计学意义(P>0.05)。改良预充组的预充工作人员满意度高于常规预充组(100.0%vs 83.3%,χ^(2)=10.583,P<0.01)。结论密闭式快速管道预充法能缩短ECPR患者临床管道预充时间、提高1次预充成功率,是一种安全、高效、满意的ECMO管道预充方法,适合对时效性要求高的ECPR患者。Objective To explore the clinical application effect of closed rapid pipeline prefilling method in extracorporeal cardiopulmonary resuscitation(ECPR)patients.Methods A total of 36 ECPR patients with cardiac arrest admitted to the Department of Emergency Medicine of Jiangsu Province Hospital from January 2018 to June 2019 were treated with conventional extracorporeal membrane oxygenation(ECMO)pipeline prefilling method(conventional group),and 78 ECPR patients admitted from September 2019 to December 2021 were treated with modified closed rapid ECMO pipeline prefilling method(modified group).Effects of two prefilling methods on priming effect,patient outcome and priming staff satisfaction were compared.Results Compared with conventional group,the success rate of one-time prefilling was higher(98.7%vs 77.8%,χ^(2)=12.110,P<0.01),and pre-charge time was shorter[(10.78±1.76)min vs(19.50±3.20)min,t=18.746,P<0.01]in modified group.There was no significant difference in serum neuronal specific enolase(NSE),Glasgow Coma Score(GCS),recovery rate of autonomic circulation and discharge rate between the two groups(P>0.05).Prefilled staff satisfaction in the modified group was higher than that in the conventional group(100.0%vs 83.3%,χ^(2)=10.583,P<0.01).Conclusion The closed rapid pipeline prefilling method can significantly shorten the clinical pipeline prefilling time of ECPR patients and improve the one-time prefilling success rate.It is a safe,efficient and satisfactory ECMO pipeline prefilling method,which is suitable for ECPR patients with a high demand for timeliness.

关 键 词：心搏骤停 体外心肺复苏 体外膜肺氧合 管道预充 密闭式快速预充 神经特异性烯醇化酶 格拉斯哥昏迷评分 

分 类 号：R473[医药卫生—护理学]