摘要
目的探讨成人心脏术后心功能不全采用周围血管插管,行静脉-动脉体外膜肺支持(V-A ECMO)发生肢体并发症的临床特点、早期诊断、防治方法。方法收集阜外心血管病医院自2004年12月至2009年12月成人心脏术后发生心功能不全采用周围血管插管(腋或者股动脉-股静脉)行V-A ECMO辅助,发生肢体并发症病例相关资料,进行回顾分析。结果共74例患者采用周围血管插管进行V-A ECMO心功能支持,发生肢体并发症10例(13.5%)。10例中男7例,女3例。右腋动脉-右股静脉插管1例;右股动脉-右股静脉插管9例。动脉插管方式:切开动脉插入插管,外置阻断带阻断动脉远端血流,远端肢体依靠自体侧支以及动脉管路侧孔分出远端供血管(直径3 mm)供血(其中右腋动脉插管病例未插远端供血管);静脉插管方式:右股静脉缝置荷包插管。其中7例患者临床表现为:插管侧下肢远端可见深紫色瘀斑、足趾甲床瘀血、小腿或足肿胀、皮肤散在水泡;皮温低、足背动脉搏动消失,考虑为静脉回流不畅所致。3例患者临床表现为远端肢体散在浅紫色皮肤花斑,无肿胀,皮温低、动脉搏动消失,甲床苍白,考虑为动脉供血不足引起。10例患者中2例因当时病情危重,虽出现肢体并发症,无法进行进一步有创处理,其中1例心功能稳定后肢体坏死,截肢出院,另外1例心功能稳定后撤除ECMO,准备处理坏死下肢时,患者死亡。1例经小腿切开减张痊愈。1例经肢端静脉引流、小腿切开减张、股动脉泵入肝素及罂粟碱、股静脉取栓等治疗后,右足底、大母趾、二趾、小趾仍留有黑色瘀斑出院继续治疗,结果无法追踪。1例患者下肢稍肿胀、肌力差,行股动脉取栓,未取出栓子,后转外院治疗,结果无法追踪。1例右腋动脉、右股静脉插管辅助患者辅助6 h后出现远端肢体缺血表现,于24 h内撤除ECMO痊愈。其余4例患者均早期死亡,死亡原因为心�
OBJECTIVE To investigate the diagnosis and treatment of limb complications on patients managed by peripheral veno-arterial extracorporeal membrane oxygenation（V-A ECMO）.METHODS A total of 10 cases that occurred limb complications in 74 patients managed by peripheral V-A ECMO at Fuwai Hospital from December 2004 to December 2009 were examined retrospectively.RESULTS 74 patients were placed on peripheral V-A ECMO.Of these,10 occurred limb complications.9 had femoral cannulation.In these 9 patients distal limb were cannulated prophylactically a distal lower extremity artery at the time of initial ECMO cannulation.1 had right axillary artery and right femoral vein cannulation without distal limb perfusion.In all these 10 patients,3（including right axillary artery and right femoral vein cannulation） had paleness,lower skin temperature and impalpable pulse of distal limbs were diagnosed ischemia.7 had cyanosis and edema of the lower limb diagnosed venous stasis.3 ischemia patients were treated with giving heparin and narceine through distal perfusion cannulation or wean off ECMO in time if cardiac function was recovery.7 venous stasis patients were treated with distal venous drainage,removal of venous thrombus by Fogarty balloon catheter,fasciotomy and so on.CONCLUSION Lower temperature,edema,cyanosis,paleness and impalpable pulse are most important signs of limb complications.The annulations limbs should be observed carefully if any abnormal signs occur,relevant management was given in time.This will greatly decrease injury.
出处
《中国体外循环杂志》
2011年第1期6-8,31,共4页
Chinese Journal of Extracorporeal Circulation
关键词
体外膜肺氧合
周围血管插管
肢体并发症
Extracorporeal membrane oxygenation
Peripheral veno-arterial annulations
Complications
