体外生命支持期间的脑微栓塞：单中心队列研究。
Cerebral microemboli during extracorporeal life support: a single-centre cohort study.
机构信息
Department of Anaesthesia, Critical Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.
Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.
出版信息
Eur J Cardiothorac Surg. 2021 Dec 27;61(1):172-179. doi: 10.1093/ejcts/ezab353.
OBJECTIVES
The aim of this study was to investigate the load and composition of cerebral microemboli in adult patients undergoing venoarterial extracorporeal life support (ECLS).
METHODS
Adult ECLS patients were investigated for the presence of cerebral microemboli and compared to critically ill, pressure-controlled ventilated controls and healthy volunteers. Cerebral microemboli were detected in both middle cerebral arteries for 30 min using transcranial Doppler ultrasound. Neurological outcome (ischaemic stroke, global brain ischaemia, intracerebral haemorrhage, seizure, metabolic encephalopathy, sensorimotor sequelae and neuropsychiatric disorders) was additionally evaluated.
RESULTS
Twenty ECLS patients (cannulations: 15 femoro-femoral, 4 femoro-subclavian, 1 femoro-aortic), 20 critically ill controls and 20 healthy volunteers were analysed. ECLS patients had statistically significantly more cerebral microemboli than critically ill controls {123 (43-547) [median (interquartile range)] vs 35 (16-74), difference: 88 [95% confidence interval (CI) 19-320], P = 0.023} and healthy volunteers [11 (5-12), difference: 112 (95% CI 45-351), P < 0.0001]. In ECLS patients, 96.5% (7346/7613) of cerebral microemboli were of gaseous composition, while solid cerebral microemboli [1 (0-5)] were detected in 12 out of 20 patients. ECLS patients had more neurological complications than critically ill controls (12/20 vs 3/20, P = 0.003). In ECLS patients, a high microembolic rate (>100/30 min) tended to be associated with neurological complications including ischaemic stroke, neuropsychiatric disorders, sensorimotor sequelae and non-convulsive status epilepticus (odds ratio 4.5, 95% CI 0.46-66.62; P = 0.559).
CONCLUSIONS
Our results indicate that adult ECLS patients are continuously exposed to many gaseous and, frequently, to few solid cerebral microemboli. Prolonged cerebral microemboli formation may contribute to neurological morbidity related to ECLS treatment.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, NCT02020759, https://clinicaltrials.gov/ct2/show/NCT02020759?term=erdoes&rank=1.
目的
本研究旨在探讨成人接受动静脉体外膜肺氧合（ECLS）治疗时脑微栓子的负荷和成分。
方法
对接受 ECLS 治疗的成人患者进行脑微栓子的检测，并与危重症、压力控制通气的对照组和健康志愿者进行比较。使用经颅多普勒超声对双侧大脑中动脉进行 30 分钟的脑微栓子检测。此外，还评估了神经功能结局（缺血性脑卒中、全脑缺血、颅内出血、癫痫发作、代谢性脑病、感觉运动后遗症和神经精神障碍）。
结果
共分析了 20 例 ECLS 患者（插管：15 例股-股，4 例股-锁骨下，1 例股-主动脉）、20 例危重症对照组和 20 例健康志愿者。ECLS 患者的脑微栓子数量明显多于危重症对照组{123（43-547）[中位数（四分位距）] vs 35（16-74），差异：88[95%置信区间（CI）19-320]，P=0.023}和健康志愿者{11（5-12），差异：112（95%CI 45-351），P<0.0001}。在 ECLS 患者中，96.5%（7613/7613）的脑微栓子为气体成分，而 20 例患者中有 12 例（12/20）检测到固体脑微栓子[1（0-5）]。ECLS 患者的神经并发症发生率高于危重症对照组（12/20 例 vs 3/20 例，P=0.003）。在 ECLS 患者中，高微栓子率（>100/30 分钟）与包括缺血性脑卒中、神经精神障碍、感觉运动后遗症和非惊厥性癫痫持续状态在内的神经并发症相关（比值比 4.5，95%CI 0.46-66.62；P=0.559）。
结论
我们的研究结果表明，成人 ECLS 患者持续暴露于大量的气体性微栓子，且常常也会有少量的固体性微栓子。长时间的脑微栓子形成可能导致与 ECLS 治疗相关的神经发病率增加。
临床试验注册
ClinicalTrials.gov，NCT02020759，https://clinicaltrials.gov/ct2/show/NCT02020759？term=erdoes&rank=1.
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