静脉-动脉体外膜肺氧合经胫后动脉逆行性远端灌注的临床效果分析  

Clinical analysis of retrograde distal perfusion via posterior tibial artery in femoral veno-arterial extracorporeal membrane oxygenation

作　　者：李坤 丁丹丹 马瑞科 韩佃明 高宗炜[1] 杜沂峰 尚庆娟 Li Kun;Ding Dandan;Ma Ruike;Han Dianming;Gao Zongwei;Yifeng Du;Qingjuan Shang(Department of Critical Care Medicine,Linyi People's Hospital,Linyi,276000,China;Department of Gynecology,Linyi Cancer Hospital,Linyi,276000,China;Pathology Diagnosis Department,Linyi People's Hospital,Linyi,276000,China)

机构地区：[1]临沂市人民医院重症医学科,临沂276000 [2]临沂市肿瘤医院妇科,临沂276000 [3]临沂市人民医院病理诊断科,临沂276000

出　　处：《中华急诊医学杂志》2024年第10期1439-1443,共5页Chinese Journal of Emergency Medicine

摘　　要：目的总结分析静脉-动脉体外膜肺氧合(V-A ECMO)经胫后动脉放置下肢灌注管(DPC)以逆行性远端灌注的方式与经验。方法回顾性分析2022年1月至2023年6月于本院接受V-A ECMO治疗并施行经胫后动脉放置DPC的15例患者的临床资料。结果15例患者V-A ECMO置管方式均为经皮穿刺置管,并均行手术切开经胫后动脉留置逆行性DPC:预防性置管6例,补救性置管9例,一次性置管成功率为93.33%,导管型号以6F鞘管为主(66.67%),预防性置管无ALI发生,补救性置管中发生1例骨筋膜室综合征,置管时间为(20.73±3.47)min。结论在V-A ECMO中,经胫后动脉放置DPC以逆行性远端灌注的方式是完全可行的,且具有较高的置管成功率,可预防或治疗下肢缺血。Objective To summarize and analyze the modalities and experience of retrograde distal perfusion with distal perfusion catheter(DPC)via cannulation of the posterior tibial artery in veno-arterial extracorporeal membrane oxygenation(V-A ECMO).Methods The clinical data of 15 patients who were treated with V-A ECMO and underwent DPC placement via the posterior tibial artery in our hospital from January 2022 to June 2023 were retrospectively analyzed.Results The V-A ECMO catheterization method in 15 patients was percutaneous puncture catheterization,and all of them underwent surgical incision to indwelling retrograde DPC through the posterior tibial artery:6 cases of preventive catheterization,9 cases of remedial catheterization,the success rate of one-time catheterization was 93.33%,and the type of catheter was mainly 6 F sheath(66.67%).There was no ALI in preventive catheterization,and one case of osteofascial compartment syndrome occurred in remedial catheterization,and the catheterization time was 20.73±3.47 min.Conclusions In V-A ECMO,placement of DPC via the posterior tibial artery for retrograde distal perfusion is perfectly feasible,and has a high success rate,which can prevent or treat lower extremity ischemia.

关 键 词：静脉-动脉体外膜肺氧合 下肢灌注管 胫后动脉 逆行性远端灌注 顺行性远端灌注 下肢缺血 经皮穿刺置管 手术切开置管 

分 类 号：R654.1[医药卫生—外科学]