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在VA-ECMO的设置中落脚:一种可能的替代性缺血机制
Abdulaziz M Alkhulaifi1, Ahsan Ehtesham1, Hafeez Lone1
1Department of Cardiothoracic Surgery, The Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
Asian cardiovascular & thoracic annals
|April 30, 2025
概括
在长时间的静脉动脉外体膜氧化 (VA-ECMO) 后,可能会出现脚下跌,但并不总是由于肢体缺血. 在VA-ECMO过程中,患者的不动和腿部的位置可能会导致神经问题,导致脚掉落.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 关键护理医学 关键护理医学
背景情况:
- 静脉动脉外体膜氧化 (VA-ECMO) 是一个重要的支持系统,经常用于外体复苏 (ECPR).
- 长时间的VA-ECMO可能会导致并发症,包括脚掉落,通常归因于四肢缺血.
研究的目的:
- 在经历长期VA-ECMO的患者中研究足部落下发育的替代机制.
- 在这个患者群体中,挑战仅仅将脚下垂归因于四肢缺血.
主要方法:
- 三名男性患者的病例系列,在长时间的外围VA-ECMO (平均22.6天) 后,他们出现了脚下垂.
- 包括偏远的股骨动脉 perfusion cannula 和逆侧的动脉内气球 (IABP).
- 综合性监测包括临床评估,多普勒超声波和远端管流量测量.
主要成果:
- 一个患者的脚在管侧,一个在逆侧,一个在双侧下落.
- 所有监测的参数,包括远端血流 (130-150毫升/分钟),都保持在正常范围内,排除了显著的缺血或隔间综合征.
- 神经传导研究给出了不确定的结果.
结论:
- 该研究提出,VA-ECMO期间腿部的定位和不移动可能会导致腹部神经的压缩或引,导致脚掉落.
- 这表明在精选的VA-ECMO患者中,脚掉落的非缺血病因.
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