| 路坤,赵士兵,陈金梦,等.改良置管方式在静脉动脉体外膜氧合中的应用[J].安徽医药,2023,27(10):2022-2026. |
| 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 |
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| DOI：10.3969/j.issn.1009-6469.2023.10.025 |
| 中文关键词: 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 |
| 英文关键词: Catheters, indwelling Oxygenators, membrane Extracorporeal membrane oxygenation Ultrasound-guided percutaneous catheterization Surgical incision and catheterization |
| 基金项目: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) |
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| 中文摘要: |
| 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(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管.45)min］ECMO撤除时间［(39.00±9.93)(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P<0.05)；改良组一次性动管成功率［ 100%(18/18)比 66.67%(16/24)］、 DPC放置成功率［ 100%(18/18)比 超声引导组(、脉置比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。 |
| 英文摘要: |
| 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. Thepatients 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 ultrasound-guided 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 catheterization complications, and simple DPC placement. |
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