| 刘少中,刘晓真,叶木奇,文鼎华,黄泳航.右心声学造影在静脉-静脉体外膜肺氧合插管中的应用初探[J].中国医学影像技术,2020,36(5): |
| 右心声学造影在静脉-静脉体外膜肺氧合插管中的应用初探 |
| The Preliminary Study of Right Heart Contrast Echocardiography during the Cannulation of Venovenous Extracorporeal Membrane Oxygenation |
| 投稿时间：2019-05-09 修订日期：2020-05-18 |
| DOI： |
| 中文关键词: 超声心动描记术 体外膜氧合作用 插管 心脏,右 声学造影 |
| 英文关键词:stroke volume variation cannulation right heart contrast echocardiography |
| 基金项目:无 |
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| 中文摘要: |
| 目的 初步探讨右心声学造影在静脉-静脉体外膜肺氧合（veno-veous extracorporeal membrane oxygenation, V-V ECMO）插管中的应用。方法 选取2017年1月至2019年2月在我院接受V-V ECMO治疗的患者18例。18例患者皆经右股静脉、右颈内静脉插管，并按插管时是否进行右心声学造影分为造影组8例和对照组10例，测量并记录中心静脉压（central venous pressure, CVP）、心输出量( cardiac output, CO)。在膜肺运转后，造影组同时进行右心声学造影，并调整下腔静脉套管尖端在下腔静脉内的位置，使下腔静脉近心段管腔内微泡接近于无，测量套管尖端与膈肌的距离(distance between cannula tip and diaphragm, Dt-d)，测量并记录左股动脉氧分压(oxygen partial pressure, PaO2)。比较两组的Dt-d、PaO2、CVP、CO。结果 造影组Dt-d、左股动脉氧分压高于对照组，差异比较有统计学意义（P＜0.05）；造影组和对照组CVP和CO比较差异无统计学意义（P＞0.05）。结论 右心声学造影有助于在V-V ECMO插管时根据评估结果进行插管位置的优化，从而减少再循环的数量，提高临床疗效。 |
| 英文摘要: |
| Objective: To explore the preliminary application of right heart contrast echocardiography during the cannulation of veno-venous extracorporeal membrane oxygenation(V-V ECMO). Methods: 18 patients who underwent V-V ECMO treatment in our hospital from January 2017 to February 2019 were enrolled. All of the patients underwent right femoral vein and right internal jugular vein cannulation, and were divided into contrast group(8 cases) and control group(10 cases) according to whether accepting right heart contrast echocardiography at the time of cannulation. Central venous pressure(CVP) and cardiac output (CO) was measured and recorded. After the ECMO initiating, the contrast group simultaneously performed right heart contrast echocardiography, and the position of the right femoral cannula tip in the inferior vena cava was adjusted so that the number of the contrast bubbles in inferior vena cava nearly vanished. The distance between cannula tip and diaphragm(Dt-d) was measured, as well as the left femoral artery oxygen partial pressure (PaO2). The Dt-d, PaO2, CVP, and CO of the two groups were compared. Results: The Dt-d and left femoral artery PaO2 in the contrast group were higher than those in the control group, and the differences were statistically significant (P<0.05). There were no significant differences in CVP and CO between the contrast group and the control group (P>0.05). Conclusion: Right heart contrast echocardiography helps to optimize the position of the cannula during the cannulation of the V-V ECMO, thereby reducing the quantity of recirculations and improving clinical outcomes. |
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