身材矮小与体外生命支持期间下肢缺血的发生有关。

Short stature is associated with the development of lower limb ischaemia during extracorporeal life support.

作者信息

Park Byoung-Won, Lee So-Ryoung, Lee Min-Ho, Bang Duk Won, Hyon Min-Su, Chang Won-Ho, Oh Hong Chul, Park Young Woo, Park Suyeon

机构信息

1 Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea.

2 Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Hospital, Seoul, Korea.

出版信息

Perfusion. 2018 Jul;33(5):383-389. doi: 10.1177/0267659118755273. Epub 2018 Feb 2.

DOI:10.1177/0267659118755273

PMID:29393012

Abstract

BACKGROUND

Percutaneous cannulation of femoral vessels has been widely used for the rapid deployment of extracorporeal life support (ECLS). Limb ischaemia is a devastating complication in patients receiving ECLS. Our aim was to evaluate the predictors of limb ischaemia during ECLS and to determine the role of preventative distal perfusion.

METHODS

Two hundred and fifty-five consecutive patients who received veno-arterial ECLS due to cardiac and/or respiratory failure were enrolled from January 2009 to December 2015. All patients received ECLS for more than 6 hours and the data was reviewed retrospectively. Distal perfusion to minimise lower limb ischaemia was performed at the discretion of the physician. Predictors for lower limb ischaemia during ECLS were analysed using multivariate regression analysis.

RESULTS

For the 255 patients, the mean age was 58 and 177 (69.4%) were male. Limb ischaemia developed in 24 patients (9.4%); 178 patients (69.8%) died within 30 days. Among the 24 patients, one patient (4.2%) developed limb ischaemia with preventative distal perfusion. Fourteen patients (58.3%) received therapeutic distal perfusion. After distal perfusion, two patients (8.3%) still required surgical intervention. Limb ischaemia was more frequent in female patients (54.2% in the ischaemia group versus 28.1% in the non-ischaemia group, p=0.008) and shorter patients (162.0 ± 9.5 cm in the ischaemia group versus 166.3 ± 9.1 cm in the non-ischaemia group, p=0.027). Patients shorter than 165 cm were more commonly diagnosed with ischaemia compared to those who were taller than 165 cm (79.2% versus 40.7%, p<0.001). In a multivariate regression analysis, height under 165 cm was the only predictor for limb ischaemia (Odds ratio (OR) [95% confidence interval (CI)] = 12.645 [3.190-50.118]).

CONCLUSION

Smaller female patients are more prone to developing limb ischaemia from femoral ECLS. Our findings might support preventative distal perfusion and more careful observation of these patients.

摘要

背景

股血管的经皮插管已广泛用于体外生命支持（ECLS）的快速部署。肢体缺血是接受ECLS患者的一种毁灭性并发症。我们的目的是评估ECLS期间肢体缺血的预测因素，并确定预防性远端灌注的作用。

方法

2009年1月至2015年12月连续纳入255例因心脏和/或呼吸衰竭接受静脉-动脉ECLS的患者。所有患者接受ECLS超过6小时，数据进行回顾性分析。医生酌情进行远端灌注以尽量减少下肢缺血。使用多因素回归分析ECLS期间下肢缺血的预测因素。

结果

255例患者中，平均年龄58岁，男性177例（69.4%）。24例患者（9.4%）发生肢体缺血；178例患者（69.8%）在30天内死亡。在24例患者中，1例患者（4.2%）在进行预防性远端灌注时发生肢体缺血。14例患者（58.3%）接受了治疗性远端灌注。远端灌注后，2例患者（8.3%）仍需要手术干预。女性患者肢体缺血更常见（缺血组为54.2%，非缺血组为28.1%，p = 0.008），身材较矮的患者也是如此（缺血组为162.0±9.5 cm，非缺血组为166.3±9.1 cm，p = 0.027）。与身高超过165 cm的患者相比，身高低于165 cm的患者更常被诊断为缺血（79.2%对40.7%，p<0.001）。在多因素回归分析中，身高低于165 cm是肢体缺血的唯一预测因素（比值比（OR）[95%置信区间（CI）]= 12.645 [3.190 - 50.118]）。