轴静脉作为VV-ECMO通道的替代静脉接入点:一个案例报告
Tao Pan1, Xiaoyang Zhou1, Jianneng Pan1
1Department of Intensive Care Medicine, Ningbo No.2 Hospital, Ningbo, 315000, Zhejiang, China.
Journal of cardiothoracic surgery
|March 14, 2024
概括
当标准的内静脉无法进入时,脉静脉道为毒性体外膜氧化 (VV-ECMO) 提供了一种可行的替代方案. 这一案例证明了它在患有严重急性呼吸困扰综合征 (ARDS) 的患者中得到了成功的应用.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 临界护理医学 临界护理医学
背景情况:
- 超声指导的皮肤下下静脉管治疗是公认的安全性和有效性,可与内静脉管治疗相提并论.
- 关于用于毒性体外膜氧化 (VV-ECMO) 的脉静脉管的报道并不频繁.
研究的目的:
- 报告一个成功的股骨-骨VV-ECMO的案例,使用骨静脉通道作为另一种接入点.
- 为了评估VV-ECMO的腹静脉管的可行性,在一个对内静脉接入有禁忌的患者中.
主要方法:
- 一名64岁的男性患有严重的吸入性肺炎引起的急性呼吸困扰综合征 (ARDS) 需要VV-ECMO支持.
- 通过超声波发现内静脉发生了血栓形成,因此需要选择其他途径.
- 在超声波指导下,选择了右下静脉用于返回管,确定了股骨-下静脉VV-ECMO.
主要成果:
- 启动VV-ECMO导致患者的氧化水平显著改善.
- 该程序在没有出血并发症,血管损伤或静脉回归问题的情况下完成.
- 尽管ECMO支持取得了成功,但该患者最终因高血引起的心室动而死亡.
结论:
- 当内静脉进入受到损害时,脉静脉作为VV-ECMO返回道的实用替代接入点.
- 超声指导对于在重症监护机构安全有效地进行尾静脉管治疗至关重要.
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