股动静脉插管方式对下肢并发症的影响分析

目的分析股动静脉插管方式对成人心脏术后行体外膜肺氧合(V-A ECMO)治疗时下肢并发症的影响。方法收集2010年1月至2012年3月阜外医院成人心脏术后行V-A ECMO 13例患者临床资料。以插管侧下肢肿胀为肢体并发症诊断标准。对患者临床资料进行回顾性分析。本组患者股静脉插管方式相同,股动脉插管有人工血管股动脉端侧吻合(n=5)、分支动脉供血管插管(n=8)两种方法。结果 13例患者中4例发生下肢并发症。两种插管方式各有并发症2例,超声方法测得2例插管侧股浅动脉(SFA)流量分别为162 ml/min和402 ml/min,高于正常值,其中流量为402 ml/min患者肿胀相对严重。采用medtronic离心泵流量计测得2例分支动脉供血管流量为220 ml/min和420 ml/min,经部分夹闭分支动脉供血管,控制流量约在150 ml/min,肿胀轻,没有进一步加重。结论动脉奢灌、充血,股静脉插管远端静脉回流相对不畅,可能是本组病例发生肢体并发症主要原因。通过对分支动脉供血管进行控制,可以降低插管侧股浅动脉流量,减缓、阻止肢体肿胀加重。

Retrospective analysis about femoral vessels cannulation for extracorporeal membrane oxygenation

Objective To investigate the mechanism of limb complications on patients during femoral vessels cannulation for extracorporeal membrane oxygenation （ECMO）. Methods A total of 13 cases managed by femoral vessels cannulation for ECMO at Fuwai Hospital from January 2010 to March 2012 were examined retrospectively. Two artery cannulation strategies were used. One strategy was： a Dacron graft was sutured to common femoral artery （CFA） and artery cannula was connected to the Dacron graft for per- fusion in 5 patients. In this way, limb complications occurred in 2 patients, whose cannulation limbs were edema and the superficial femoral artery （SFA） flow measured by ultrasonic was higher than normal （ 162 ml/min and 402 ml/min respectively）. Another strate- gy was： atery cannula was inserted into CFA for ECMO support, at same time the ECMO circuit was branched prophylactically with separate cannulation inserted into SFA for distal limb perfusion. In this way, limb complications occurred in 2 patients, whose cannula- t＇ion limbs were edema and the SFA flow measured by flow meter of centrifugal pump was higher than normal （220 ml/min and 420 ml/ rain respectively）. Flow could he reduced by partially clamping the branch tube from ECMO circuit to the SFA. All femoral veins can- nulation were accomplished using Seldinger$ technique under direct vision. Results Limb complications occurred in 4 patients. Both artery cannulation strategies had 2 cases. Conclusion Perhaps too much SFA flow to distal limb and distal venous obstruction due to the venous cannula contribute to limb complication.