2022 年第 3 期 第 17 卷

股动脉-人造血管端侧吻合对行静脉-动脉体外膜氧合治疗的心力衰竭患者并发症的影响

Effect of end-to-side femoral artery-artificial vascular anastomosis on complications of heart failure patients undergoing venous-arterial extracorporeal membrane oxygenation therapy

作者：杜志明陈洪付金凤钟学洪唐志贤刘子由

英文作者：Du Zhiming Chen Hong Fu Jinfeng Zhong Xuehong Tang Zhixian Liu Ziyou

单位：赣南医学院第一附属医院心脏大血管外科,赣州341000

英文单位：Department of Cardiothoracic Surgery First Affiliated Hospital of Gannan Medical University Ganzhou 341000 China

关键词：心力衰竭；体外膜氧合；人造血管；吻合

英文关键词：Heartfailure;Extracorporealmembraneoxygenation;Artificialbloodvessel;Anastomosis

• 摘要：

• 目的 探讨股动脉-人造血管端侧吻合对行静脉-动脉体外膜氧合（VA-ECMO）治疗的心力衰竭患者并发症的影响。方法  回顾性分析2018年1月至2020年12月赣南医学院第一附属医院收治的46例行VA-ECMO治疗的心力衰竭患者临床资料。其中采用常规插管建立向远端肢体的侧支循环24例（对照组），采用股动脉-人造血管端侧吻合22例（观察组）。比较2组主要疾病、并存疾病、左心室射血分数（LVEF）和欧洲心脏手术风险评估系统(EuroSCORE)Ⅱ评分等术前基本资料，以及ECMO辅助循环时间、手术时间，应用连续肾脏替代疗法（CRRT）比例，术后并发症发生率，成功脱机率和院内病死率等手术相关指标，以及术后2个月的生存率。结果 2组术前主要疾病、并存疾病、LVEF和EuroSCOREⅡ评分，ECMO辅助循环时间，应用CRRT比例、成功脱机率、院内病死率和术后2个月生存率比较差异均无统计学意义（均P＞0.05）；观察组手术时间长于对照组，术后24 h出血、远端肢体缺血、切口感染、切口延迟愈合发生率均低于对照组［27.3%（6/22）比62.5%（15/24），4.5%（1/22）比25.0%（6/24），13.6%（3/22）比54.2%（13/24），13.6%（3/22）比45.8%（11/24）］,但远端肢体高灌注发生率高于对照组［18.2%（4/22）比0（0/24）］（均P＜0.05）。结论  在VA-ECMO治疗中，行股动脉-人造血管端侧吻合插管可改善插管部位出血、远端肢体缺血和切口感染情况，但可能导致远端肢体高灌注情况。

• Objective   To explore the effect of end-to-side femoral artery-artificial vascular anastomosis on complications of heart failure patients undergoing venous-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy. Methods   The clinical data of 46 heart failure patients treated with VA-ECMO who were admitted to First Affiliated Hospital of Gannan Medical University from January 2018 to December 2020 were retrospectively analyzed. Among them, conventional intubation was used to establish collateral circulation to the distal limbs in 24 cases (control group), and end-to-side femoral artery-artificial vascular anastomosis in 22 cases (observation group). The preoperative basic data such as major diseases, comorbid diseases, left ventricular ejection fraction (LVEF) and European Heart Surgery Risk Assessment System (EuroSCORE) Ⅱ score, and related surgical indicators such as ECMO auxiliary circulation time, operation time, continuous renal replacement therapy (CRRT) treatment status, postoperative complication rate, successful weaning rate and hospital mortality, as well as the survival rate of 2 months after surgery were compared between the two groups. Results  There were no statistically significant differences between the two groups in major diseases, comorbid diseases, LVEF, EuroSCOREⅡ score and ECMO auxiliary circulation time before operation, CRRT rate, successful weaning rate, hospital mortality and 2-month survival rate after surgery (all P>0.05). The operation time of the observation group was longer than that of the control group, and the incidences of postoperative bleeding within 24 h, distal limb ischemia, wound infection, and delayed wound healing of the observation group were lower than those of the control group ［27.3%(6/22) vs 62.5%(15/24), 4.5%(1/22) vs 25.0%(6/24), 13.6%(3/22) vs 54.2%(13/24), 13.6%(3/22) vs 45.8%(11/24)］, while the incidence of high perfusion in the distal limbs of the observation group was higher than that of the control group ［18.2%(4/22) vs 0（0/24）］(all P<0.05). Conclusion In VA-ECMO therapy, end-to-side femoral artery-artificial vascular anastomosis catheterization can reduce occurrences of the bleeding at the cannulation site, distal limb ischemia and incision infection, but it may lead to high perfusion of the distal limb.