Application of ProGlide pre-close technique in establishment of percutaneous venoarterial extracorporeal membrane oxygenation
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摘要:
目的 评价ProGlide血管缝合器预缝合技术（PCT）在经皮穿刺静-动脉模式体外膜肺氧合（VA-ECMO）血管通路撤机止血中应用的有效性及安全性。 方法 研究为前瞻性、观察性研究，连续入选2019年3月～2020年6月期间在空军军医大学西京医院心脏内科接受经皮穿刺VA-ECMO治疗的患者。将成功撤机并利用PCT技术完成血管通路缝合的患者纳入研究，分别记录PCT技术在股动、静脉的成功率及住院期间穿刺部位相关并发症发生率。 结果 研究共纳入37例接受经皮穿刺VA-ECMO治疗患者，排除5例患者（其中1例是未采用PCT技术，4例在ECMO撤机前死亡），最终纳入32例患者，结果发现PCT技术在股动脉的技术成功率为97%、股静脉成功率为100%。所有患者住院期间未发生主要血管并发症，次要血管并发症发生率为6%。 结论 ProGlide预缝合技术在经皮穿刺VA-ECMO撤机时可以安全有效地实现股动、静脉的快速止血，且血管并发症发生率低。 Abstract:AIM To evaluate the feasibility and safety of per-close technique for achieving vascular hemostasis using the ProGlide system in patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO). METHODS The study subjects were 32 consecutive patients with V-A ECMO between March 2019 and June 2020, in whom pre-close technique was used to achieve hemostasis at the puncture site using a ProGlide system. Technique success rate and the incidence of vascular complications at puncture site were recorded until their discharge. RESULTS The pre-close technique was performed in 32 patients. The technique success rate in the femoral artery was 97% and in the femoral vein was 100%. One patient required the use of Angioseal device for femoral artery to achieve hemostasis after weaning from ECMO. The rate of procedure-related minor vascular complications was 6%. Two patients were found with hematoma by ultrasound in the femoral artery access site. No major vascular complications occurred during the periprocedural period. CONCLUSION This study indicates that the ProGlide pre-close technique is safe and efficacious in achieving hemostasis, whether in femoral artery or in vein after weaning from VA-ECMO. -
表 1 研究对象的临床基线资料
（n=32） 项目 数值 年龄（岁） 68±8 男性 28（88） 体质量(kg) 68.1 合并症 高血压 19(59） COPD 4(12） 糖尿病 12(38) 慢性肾功能不全 5(16) 外周动脉疾病 27(84) 启动ECMO支持的原因 复杂高危冠脉介入治疗围术期支持 30(94) 经导管主动脉瓣置换围术期预防性置入 2(6) 表中计数资料均为[例数（%）] 
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表 2 32例患者ProGlide血管PCT成功率和并发症发生率（n=32）
项目 数值 技术成功率 股动脉 31（97） 股静脉 32（100） 血管并发症 次要血管并发症 血肿（<6 cm） 2（6） 不需输血的穿刺点出血 0（0） 穿刺点感染 0（0） 可自行闭合的假性动脉瘤 0（0） 主要血管并发症 腹膜后出血 0（0） 急性下肢缺血 0（0） 动脉闭塞 0（0） 静脉闭塞 0（0） 需要特殊处理的假性动脉瘤 0（0） 需要输血的穿刺点出血 0（0） 外科手术干预 0（0） 表中计数资料均为[例数（%）]
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