摘要
目的回顾性分析静脉-动脉体外膜肺氧合(venous-arterial extracorporeal membrane oxygenation,V-A ECMO)不同抗凝策略导致的出血和血栓并发症及住院存活情况。方法将2017年10月至2020年12月就诊于四川省人民医院急诊监护室使用V-A ECMO并且ECMO运转时间超过24 h的72例心肺衰竭患者纳入研究。通过活化凝血时间(activated clotting time,ACT)分组,即ACT 140~180 s为低强度抗凝组和ACT 180~220 s为高强度抗凝组,比较两组住院存活率、出血和血栓并发症发生率。结果共有35例患者符合纳入标准,低强度抗凝组16例,高强度抗凝组19例。低强度抗凝组住院存活率显著高于高强度抗凝组(68.75%vs.21.05%,P<0.05);低强度抗凝组出血并发症发生率显著低于高强度抗凝组(43.75%vs.89.47%,P<0.05),其中颅内出血率和穿刺部位出血率低强度抗凝组显著降低(18.75%vs.73.68%,P<0.05;31.25%vs.73.68%,P<0.05);低强度抗凝组输注红细胞悬液量显著低于高强度抗凝组[U:2(1.5,3.5)vs.6.3(3.6,12.4),P<0.05];低强度抗凝组第2天凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体及第3天PT显著低于高强度抗凝组(P<0.05)。结论在V-A ECMO运行中,低强度抗凝策略是相对安全的。
Objective The bleeding and thrombosis complications and hospital survival caused by different anti-coagulation strategies of venous-arterial extracorporeal membrane oxygenation(V-A ECMO)were retrospectively analyzed.Methods Seventy-two patients with cardiopulmonary failure requiring V-A ECMO and their ECMO operation time was longer than 24 h in the Emergency Care Unit of Sichuan Provincial People’s Hospital from October 2017 to December 2020 were included in the study.The patients were divided into two groups by activated clotting time(ACT),which ranged 140-180 s for low anticoagulation intensity group,and 180-220 s for high anticoagulation intensity group.The survival rate,bleeding and thrombosis rates of the two groups were compared.Results A total of 35 patients met the inclusion criteria,16 patients in the low anticoagulation intensity group and 19 patients in the high anticoagulation intensity group.The results showed that the hospitalization survival rate of low anticoagulation intensity group was significantly higher than that of high anticoagulation intensity group(68.75%vs.21.05%,P<0.05).In addition,the incidence of bleeding complications in the low anticoagulation intensity group was significantly lower than that in the high anticoagulation intensity group(43.75%vs.89.47%,P<0.05).The intracranial bleeding rate and puncture site bleeding rate in the low anticoagulation intensity group were significantly lower(18.75%vs.73.68%,P<0.05;31.25%vs.73.68%,P<0.05).The amount of erythrocyte suspension in low anticoagulation intensity group was significantly lower[2(1.5,3.5)U vs.6.3(3.6,12.4)U,P<0.05);The PT,APTT,D-dimer on the second day and PT on the third day in low anticoagulation intensity group were significantly lower than those in high anticoagulation intensity group(P<0.05).Conclusions In V-A ECMO operation,the strategy of low anticoagulation intensity is relatively safe.
作者
张洋
邓磊
冯璇璘
李依
宋孟龙
王宇
常莉
周平
Zhang Yang;Deng Lei;Feng Xuan-lin;Li Yi;Song Meng-long;Wang Yu;Chang Li;Zhou Ping(Department of Emergency Intensive Care Unit,Sichuan Provincial People's Hospital,the Affiliated Hospital of Chengdu University of Electronic Science and Technology,Chengdu 610072,China)
出处
《中国急救医学》
CAS
CSCD
2021年第7期630-634,共5页
Chinese Journal of Critical Care Medicine
基金
四川省2019年重点研发计划项目(2019YFS0303)。
关键词
体外膜肺氧合(ECMO)
抗凝
存活率
出血
血栓
Extracorporeal membrane oxygenation(ECMO)
Anticoagulation
The survival rate
Bleeding
Blood clots
