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Received:February 14, 2020 Published Online:October 20, 2020
Received:February 14, 2020 Published Online:October 20, 2020
中文摘要: 目的 初步探讨经胸超声心动图、血管超声及腹部超声在静脉-动脉体外膜肺氧合(V-A ECMO)围治疗期患者治疗前基本情况的评估,及插管中、ECMO支持治疗期间、拔管后并发症监测中的应用价值。
方法 纳入2018年4月至2019年8月在西安交通大学第一附属医院就诊的因心脏功能衰竭需V-A ECMO支持治疗的患者21例,依次分析超声心动图、血管超声及腹部超声在插管前患者基本情况评估中的作用，及在插管过程中、ECMO支持治疗期间及脱机后心脏及血管相关并发症监测中的作用。
结果 行ECMO支持治疗的21例患者中急性冠脉综合征12例，爆发性心肌炎5例,心脏手术后3例和心脏骤停1例,5例(23.8%)在ECMO支持治疗期间死亡,16例(76.2%)存活至拔管，10例(47.6%)存活至出院。ECMO治疗前超声监测:左室整体收缩功能正常患者2例(9.5%),异常19例(90.5%,其中轻度减低3例,中度减低9例,重度减低7例);右室收缩功能正常患者14例(66.7%),异常7例(33.3%)。6例(28.6%)患者在插管前需根据股动脉粥样硬化结果筛选出狭窄程度较轻侧进行插管。插管时超声监测:15例(71.4%)初次插管成功,6例(28.6%)需超声引导下调整套管末端位置;2例(9.5%)超声提示需调整侧枝循环或重新建立侧枝循环。ECMO支持治疗过程中及脱机后超声监测:1例(4.8%)需在超声引导下调整套管末端位置;主要并发症是血栓栓塞,包括支持治疗过程中2例(9.5%)静脉置管周围血栓形成和脱机后2例(9.5%)股动脉缝合口处血栓形成。V-A ECMO围治疗期无不良事件发生。
结论 在超声的术前评估及引导下,单腔V-A ECMO插管成功率较高,并且能及时发现并发症,有助于减少V-A ECMO围治疗期的严重并发症发生。
Abstract:Objective To explore the application value of transthoracic echocardiography,vascular ultrasound and abdominal ultrasound in evaluating the basic situation of patients before undergoing venous-arterial extracorporeal membrane oxygenation (V-A ECMO) and in monitoring complications during V-A ECMO.
Methods A total of twenty-one patients with heart failure undergoing V-A ECMO support treatment from April 2018 to August 2019 were included.Assessed by echocardiography,vascular ultrasound and abdominal ultrasound,the patients′ basic condition before intubation and the changes in cardiac and vascular during intubation,V-A ECMO and after ECMO support and related complications were analyzed.
Results There were 12 cases of acute coronary syndrome,5 cases of fulminant myocarditis,3 cases after cardiac surgery,1 case of cardiac arrest,5 cases (23.8%) died during ECMO support treatment,16 cases (76.2%) survived to extubation and 10 cases (47.6%) survived to discharge.Before ECMO,there were 2 cases(9.5%) with normal left-ventriculas systolic function,19 cases (90.5%)with abnormal left-ventricular systolic function,including 3 cases of mild reduction,9 cases of moderate reduction and 7 cases of severe reduction.There were 14 cases (66.7%) with normal right-ventricular systolic function and 7 cases (33.3%) with abnormal right ventricular systolic function.
Six patients(28.6%) needed to select the lighter side of stenosis for intubation according to the results of femoral atherosclerosis before intubation.
During intubation,ultrasound monitoring showed that there were 15 cases (71.4%) of successful initial intubation,6 cases (28.6%) needed to adjust the end position of the cannula under the guidance of ultrasound and 2 cases (9.5%) needed to adjust or reestablish the collateral circulation.Ultrasound monitoring during and after ECMO support treatment showed 1 case (4.8%) needed to adjust the end position of the cannula under the guidance of ultrasound.Thromboembolism was the main complication,including 2 cases (9.5%) of thrombosis around the venous catheter during supportive treatment and 2 cases (9.5%) at the femoral artery suture after offline.No adverse events occurred during the V-A ECMO period.
Conclusion With the preoperative evaluation and guidance of ultrasound,the success rate of single-lumen V-A ECMO intubation is very high,and the complications can be found immediately,which can help to reduce the occurrence of severe complications druing peri-treatment period of the V-A ECMO.
keywords: Extracorporeal life support Veno-Arterial extracorporeal membrane oxygenation Ultrasound Acute heart failure Cardiac function assessment Large vessels Peripheral vessels Cannula approach and location Complications
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