经股动静脉体外膜肺氧合下肢并发症的防治及管理策略

摘要

目的 总结分析经股动脉-静脉体外膜肺氧合(V-A ECMO)期间,下肢缺血及血栓并发症的防治及管理策略.方法 回顾性分析本院2014年5月至2018年3月,因循环衰竭行V-A ECMO辅助治疗的22例患者的临床资料,分析下肢远端灌注及并发症情况.结果 22例V-A ECMO辅助治疗患者中13例成功脱机(59.1％).2014年至2016年均常规经股浅动脉放置远端灌注管(17例); 2017年至今常规不放置远端灌注管,后根据临床情况及下肢超声血流决定是否放置(共5例,未放置3例,后放置2例),其中3例发生下肢肿胀,经调整后好转;花斑2例,在超声引导下置远端灌注管后好转,无1例发生下肢缺血坏死.结论 V-A ECMO是治疗急性循环衰竭的重要手段之一,下肢并发症对其预后影响较大.根据病情及辅助检查,合理安置远端灌注,做好抗凝及远端流量管理,减少致残率,提高V-A ECMO成功率及患者生存质量.%Objective To summarize the prevention and management strategy of lower extremity ischemia and thrombotic complications during femoral arteriovenous extracorporeal membrane oxygenation (ECMO). Methods Clinical data of 22 patients with ECMO (V-A mode) assisted treatment for circulatory failure from May 2014 to March 2018 were analyzed retrospectively. The distal end of lower extremity perfusion and complications of those patients were also analyzed. Results Of the 22 patients, 13 cases were successfully weaned from ECMO (59.1％). During 2014 and 2016, a distal perfusion cannula was routinely placed through superficial femoral artery (17 cases); from 2017 to present, distal perfusion cannulation was not routinely placed, and the placement was decided according to the clinical situation and lower extremity ultrasound blood flow (Of five cases, three were not cannulated whereas two were cannulated thereafter). Among them, three patients suffered from lower extremity swelling. There were two cases of macula, which improved after the distal perfusion tube was placed under the guidance of ultrasound, and no lower limb ischemia or necrosis occurred.Conclusion ECMO plays an important role in the treatment of acute circulatory failure. Lower extremity complications have great impacts on the prognosis. According to the conditions of patients, rational placement of distal perfusion, anticoagulant and distal flow management are needed to reduce the rate of disability and to improve the success rate of ECMO and the life quality of patients.