| 摘要: |
| 目的 探讨基于ProGlide血管闭合装置的后闭合技术在清醒静脉-动脉体外膜氧合（VA-ECMO）拔管中的安全性与有效性。方法 回顾性分析2017年1月至2021年6月于我院行清醒VA-ECMO救治并撤机患者的临床结局。根据使用的血管闭合方式，将患者分为ProGlide后闭合技术组（ProGlide组）和外科修复组。分析患者全因住院死亡率、动脉拔管闭合操作时间、出血相关事件、30 d内血管相关并发症等。结果 共35例患者最终纳入研究，其中21例（60.0%）使用ProGlide后闭合技术，14例（40.0%）使用外科修复技术。全组患者男 21例（60.0%）、女14例（40.0%），平均年龄（49.20±10.52）岁，VA-ECMO支持的中位时间为10.0（8.0，12.0）d，全因住院死亡率为11.4%（4/35）。多因素logistic回归分析结果显示，校正年龄、性别后，在主要观察终点中，两组的全因住院死亡率差异无统计学意义（OR＝0.78，95% CI 0.09～6.89，P＝0.826）。次要观察终点显示，ProGlide组具有更少的动脉拔管闭合操作时间（β＝14.14，95% CI 7.22～21.05，P＜0.01）及更短的撤机后ICU停留时间（β＝2.11，95% CI 0.20～4.02，P＝0.032）。两组均无主要出血事件及30 d内主要血管相关并发症发生，但ProGlide组次要出血事件及30 d内次要血管相关并发症发生率均低于外科修复组（OR＝0.13，95% CI 0.02～0.88，P＝0.036；OR＝0.05，95% CI 0.00～0.59，P＝0.018）。ProGlide组患者撤机时重症监护室疼痛观察工具法（CPOT）评分明显低于外科修复组（β＝1.26，95% CI 0.37～2.14，P＝0.007），外科修复组动脉缝合时需要额外使用瑞芬太尼的患者比例明显增加（OR＝0.06，95% CI 0.01～0.36，P＝0.002）。结论 在清醒VA-ECMO动脉拔管过程中，采用ProGlide血管闭合装置的后闭合技术是安全、有效的。与外科修复方法相比，ProGlide血管闭合装置的后闭合技术具有操作时间短、出血及血管相关并发症少、患者疼痛感轻的优势，对促进患者快速康复具有一定作用。 |
| 关键词: 血管闭合装置 ProGlide 后闭合技术 体外膜氧合作用 动脉切开术 修复 |
| DOI：10.16781/j.CN31-2187/R.20220432 |
| 投稿时间：2022-05-21修订日期：2022-06-22 |
| 基金项目:海军军医大学(第二军医大学)第一附属医院"深蓝123"军事医学研究专项——重点攻关项目(2019YSL003). |
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| Arterial closure strategy after awake veno-arterial extracorporeal membrane oxygenation decannulation: ProGlide-based post-closure technique is superior to surgical repair |
| LI Bai-ling,PAN Jia-jun,TANG Yang-feng,HAN Lin,XU Zhi-yun,WANG Jun* |
(Department of Cardiovascular Surgery, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the safety and effectiveness of the ProGlide-based post-closure technique in awake veno-arterial extracorporeal membrane oxygenation (VA-ECMO) decannulation.Methods The clinical outcomes of patients who received awake VA-ECMO treatment and removed from the machine in our hospital from Jan.2017 to Jun.2021 were retrospectively analyzed.The patients were divided into ProGlide-based post-closure technique group (ProGlide group) and surgical repair group according to the vascular closure method used.All-cause in-hospital mortality,procedure time of arterial closure decannulation,bleeding-related events,and vascular-related complications within 30 d were analyzed.Results A total of 35 patients were eventually enrolled,including 21(60.0%) with ProGlide-based post-closure technique and 14(40.0%) with surgical repair technique.There were 21 males (60.0%) and 14 females (40.0%) with a mean age of (49.20±10.52) years old.The median time of VA-ECMO support was 10.0(8.0,12.0) d,and the all-cause in-hospital mortality was 11.4%(4/35).Multivariate logistic regression analysis showed that after adjusting for age and gender,there was no significant difference in all-cause in-hospital mortality between the 2 groups (odds ratio[OR]=0.78,95% confidence interval[CI]0.09-6.89,P=0.826) at the primary end point.The secondary end point showed the ProGlide group had less procedure time (β=14.14,95%CI 7.22-21.05,P<0.01) and shorter intensive care unit (ICU) length of stay after decannulation (β=2.11,95% CI 0.20-4.02,P=0.032).There were no major bleeding events or major vascular-related complications within 30 d between the 2 groups.The ProGlide group had lower incidence of minor bleeding events or minor vascular-related complications within 30 d than the surgical repair group (OR=0.13,95%CI 0.02-0.88,P=0.036;OR=0.05,95%CI 0.00-0.59,P=0.018).The critical care pain observation tool (CPOT) score of the patients in the ProGlide group was significantly lower than that in the surgical repair group (β=1.26,95%CI 0.37-2.14,P=0.007).The need for remifentanil for arterial suturing was significantly increased in the surgical repair group (OR=0.06,95%CI 0.01-0.36,P=0.002).Conclusion ProGlide-based post-closure technique is safe and effective in the process of awake VA-ECMO decannulation.Compared with surgical repair technique,it has the advantages of shorter procedure time,less bleeding and vascular-related complications,and less pain for patients,and it has a certain role in promoting rapid recovery of patients. |
| Key words: vascular closure device ProGlide post-closure technique extracorporeal membrane oxygenation arteriotomy repair |
