摘要
目的探讨体外膜肺氧合(ECMO)穿刺置管的成功率、并发症及其影响因素。方法收集行动脉-静脉ECMO病例,分析超声引导经皮穿刺置管成功率以及并发症发生率,同时纳入性别、年龄、心功能[射血分数(EF)<30%或EF≥30%]、目标动脉管径(<5.0 mm或≥5.0 mm)、能否一次穿刺成功、高血压等变量,利用单因素和多因素logistic回归统计方法,分析体外心肺复苏(ECPR)患者(ECPR组)、非ECPR患者(非ECPR组)以及总体情况下置管成功率及并发症的影响因素。结果研究纳入65例行动脉-静脉ECMO病例,患者年龄为(49.3±18.2)岁。其中ECPR患者23例、非ECPR患者42例。超声引导下ECMO穿刺置管的总体成功率为86.2%,ECPR组的成功率为78.3%,非ECPR组的成功率为90.5%。穿刺后有13例出现血肿及5例出现远端肢体缺血。单因素及多因素logistic回归分析显示,目标动脉内径及能否一次穿刺成功是整体穿刺置管成功率的影响因素,而能否一次穿刺成功同时也是血肿发生率的影响因素(P均<0.05)。亚组分析中,ECPR组中目标动脉内径是穿刺置管成功的影响因素(P<0.05),而非ECPR组中并未发现具有统计学意义的影响因素(P均<0.05)。结论经皮超声引导ECMO穿刺置管具有较高的成功率和安全性。对于非ECPR患者以及目标动脉管径≥5 mm的患者可首选超声引导经皮穿刺行ECMO置管。同时,穿刺应该“一针到位”,既能提高最终穿刺置管成功率也能减少血肿的发生。
Objective To investigate the success rate,complications and infuencing factors of extracorporeal membrane oxygenation(ECMO)puncture and catheterization under ultrasound guidance.Methods Clinical cases of veno-arterial ECMO were collected.The success rate and incidence of complications of ultrasound-guided percutaneous catheterization were analyzed.Meantime,gender,age,cardiac function(ejection fraction(EF)<30%/EF≥30%),target artery diameter(<5.0 mm/≥5.0 mm),success of one-time puncture,hypertension and other variables were ineluded.Univariate and/or multivariate logistic regression analyses were used to analyze the influencing factors of the overall success rate and complications of catheterization in extracorporeal cardiopulmonary resuscitation(ECPR)patients(ECPR group)and non ECPR patients(non-ECPR group).Results 65 cases of veno arterial ECMO were included in the study,with an average age of(49.3±18.2)years.23 cases were assigned in the ECPR group and 42 cases in the non-ECPR group.The overall success rate of ultrasound-guided ECMO catheterization was 86%,78%in the ECPR group and 91%in non-ECPR group.13 cases developed hematoma and 5 cases of distal limb ischemia after puncture.Logistic regression analyses showed that the target artery diameter and the success of one-time puncture were the infuencing factors for the success rate of overall puncture and catheterization,and the success of one-time puncture was also the infuencing factor for the incidence rate of hematoma(all P<0.05).In subgroup analysis,the diameter of target artery was found to be a factor afcti the success rate of puncture and catheterization in the ECPR group(P<0.05),whereas no satistically significant factor was found in the non-ECPR group(all P>0.05).Conclusions Pereutaneous ultrasound guided ECMO catheterization has a high success rate and safety.For non-ECPR patients and those with target artery diameter of≥5 mm,percutancous ultrasound-guided ECMO catheterization is the optimal option.Sucessful one-time puncture should be guaranteed
作者
陈杰桓
张伟娜
刘颖培
周芙蓉
姜伟
Chen Jiehuan;Zhang Weina;Liu Yingpei;Zhou Furong;Jiang Wei(Graduate School,Guangdong Medical University,Dongguan 523000,China;不详)
出处
《新医学》
CAS
2023年第5期359-364,共6页
Journal of New Medicine
关键词
体外膜肺氧合
穿刺置管
成功率
并发症
影响因素
Extracorporeal membrane oxygenation
Puncture and catheterization
Success rate
Complication
Influencing factor
