Pranikoff T, Hirschl R B, Remenapp R, Swaniker F, Bartlett R H
Department of Surgery, The University of Michigan Medical School, Ann Arbor, USA.
Chest. 1999 Mar;115(3):818-22. doi: 10.1378/chest.115.3.818.
The objective of this study was to demonstrate the safety and utility of a method of percutaneous access for cannulation of adult patients for venovenous extracorporeal life support (ECLS).
A retrospective review of a patient series.
A surgical ICU at a university teaching hospital.
The study group consisted of 94 adults > 17 years old with respiratory failure who were placed on venovenous ECLS by means of percutaneous cannulation.
The cannulation of the internal jugular and femoral veins (FVs) using the Seldinger technique for venovenous ECLS.
Between May 1992 and November 1997, we performed percutaneous cannulation for venovenous ECLS in 94 adult patients with respiratory failure. The mean (+/- SD) age was 36.1+/-12.7 years old (range, 17 to 65 years). The mean (+/-SD) weight was 80.7+/-22.3 kg (range, 36 to 156 kg). The right internal jugular vein (RIJV) was used for venous drainage access in all but four cases. The right FV (n = 86), the left FV (n = 3), or the RIJV (n = 4) was utilized for venous reinfusion. The maximum blood flow (+/-SD) during ECLS was 57.6+/-17.5 mL/kg/min (range, 22.4 to 127.8 mL/kg/min), with a postmembrane outlet pressure (+/-SD) of 146+/-43 mm Hg (range, 56 to 258 mm Hg) at the maximum flow rate. There were 11 unsuccessful percutaneous cannulation attempts. In three patients (3%), the complications consisted of arterial injury requiring operative cutdown and repair. In six patients (6%), cannula-site bleeding required pursestring suture reinforcement of the cannula site. One patient died from the perforation of the superior vena cava during cannulation.
Based on these data, we conclude that percutaneous cannulation may be utilized to provide venovenous ECLS in adults.
本研究的目的是证明一种经皮穿刺置管方法用于成年患者静脉-静脉体外生命支持（ECLS）的安全性和实用性。
对一组患者进行回顾性研究。
一所大学教学医院的外科重症监护病房。
研究组由94名年龄大于17岁的呼吸衰竭成年患者组成，这些患者通过经皮穿刺置管接受静脉-静脉ECLS治疗。
使用Seldinger技术对颈内静脉和股静脉（FV）进行穿刺置管以实施静脉-静脉ECLS。
1992年5月至1997年11月期间，我们对94例呼吸衰竭成年患者进行了经皮穿刺置管用于静脉-静脉ECLS治疗。平均（±标准差）年龄为36.1±12.7岁（范围17至65岁）。平均（±标准差）体重为80.7±22.3千克（范围36至156千克）。除4例患者外，其余所有患者均采用右颈内静脉（RIJV）作为静脉引流通路。右股静脉（n = 86）、左股静脉（n = 3）或右颈内静脉（n = 4）用于静脉再灌注。ECLS期间的最大血流量（±标准差）为57.6±17.5毫升/千克/分钟（范围22.4至127.8毫升/千克/分钟），在最大流速时膜后出口压力（±标准差）为146±43毫米汞柱（范围56至258毫米汞柱）。有11次经皮穿刺置管尝试未成功。3例患者（3%）出现并发症，包括需要手术切开和修复的动脉损伤。6例患者（6%）穿刺部位出血，需要对穿刺部位进行荷包缝合加固。1例患者在置管过程中死于上腔静脉穿孔。
基于这些数据，我们得出结论，经皮穿刺置管可用于为成年患者提供静脉-静脉ECLS。
