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| 泵控逆流试验在静脉-动脉体外膜肺氧合患者撤机中的应用 |
| Application of pump-controlled retrograde trial off in weaning patients with veno-arterial extracorporeal membrane oxygenation |
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| DOI：10.12089/jca.2025.10.011 |
| 中文关键词: 泵控逆流试验 静脉-动脉体外膜肺氧合 出血 血栓 心源性休克 |
| 英文关键词: Pump-controlled retrograde trial off Veno-arterial extracorporeal membrane oxygenation Bleeding Thrombosis Cardiogenic shock |
| 基金项目:国家自然科学基金面上项目（82071903） |
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| 中文摘要: |
目的：比较泵控逆流试验（PCRTO）和连续降低辅助流量在静脉-动脉体外膜肺氧合（VA-ECMO）患者撤机中的应用效果。
方法：选择2022年2月至2024年9月因暴发性心肌炎或心肌梗死行VA-ECMO治疗的心源性休克（CS）且符合撤机试验标准的患者70例，男46例，女24例，年龄18～64岁，BMI 15.0～30.0 kg/m2。采用随机数字表法将患者分为两组：连续降低辅助流量组（C组）和PCRTO组（P组），每组35例。C组撤机方案：连续递减辅助流量直至达到0.5～1.0 L/min的空转流量，评估左心功能和血流动力学稳定性。P组撤机方案：减低ECMO离心泵转速直至ECMO回路血流逆行，评估全心功能和血流动力学稳定性。记录ECMO撤机成功例数、ECMO撤机试验时间、ECMO运行时间、撤机后30 d生存情况及死亡相关并发症（脑出血、撤机后CS、多器官功能障碍、肺部感染）发生情况。记录ECMO撤机试验内出血和血栓事件发生情况、血制品用量及撤机后的凝血相关指标。
结果：与C组比较，P组撤机成功率明显升高(P<0.05)，撤机试验时间明显延长（P<0.05），撤机后CS发生率、撤机试验内血栓形成率、回路血栓发生率以及撤机后24 h乳酸浓度明显降低（P<0.05）。两组ECMO运行时间、撤机后30 d生存率及死亡相关并发症发生率差异无统计学意义。
结论：PCRTO方案是一种安全、有效的撤机方案，在VA-ECMO患者中可以提高撤机成功率，减少撤机后CS的发生率，且撤机过程中血栓事件发生率低。 |
| 英文摘要: |
Objective: To explore the safety and efficacy of pump-controlled retrograde trial off (PCRTO) compared with continuously decremental pump flow reduction in adult veno-arterial extracorporeal membrane oxygenation (VA-ECMO) weaning.
Methods: Seventy VA-ECMO-treated patients with cardiogenic shock (CS) due to fulminant myocarditis or myocardial infarction from February 2022 to September 2024, 46 males and 24 females, aged 18-64 years, BMI 15.0-30.0 kg/m2 and meeting the criteria of the weaning trial, were enrolled and divided into two groups by random number table method: PCRTO protocol group (group P) and continuously decremental pump flow reduction protocol group (group C), 35 patients in each group. In group C, the assisted flow was continuously decreased until the idling flow of 0.5-1.0 L/min was reached, and the left ventricular function and hemodynamics were evaluated. In group P, the speed of ECMO centrifugal pump was reduced until the blood flow in ECMO circuit was reversed, and the global cardiac function and hemodynamics were evaluated. The number successful of ECMO weaning, ECMO running time, ECMO weaning trial time, 30-day survival after weaning, and incidence of death related complications (cerebral hemorrhage, CS after weaning, multiple organ dysfunction, and pulmonary infection) were collected and recorded. The incidence of bleeding and thrombosis events were recorded during ECMO weaning trial time. The consumption of blood products during ECMO weaning trial time and coagulation related indicators after weaning were recorded.
Results: Compared with group C, the weaning success rate was significantly increased, the duration of weaning test was significantly prolonged, the incidence of CS after weaning, thrombosis, circuit thrombosis, and the concentration of lactic 24 hours after weaning were significantly decreased in group P (P < 0.05). There were no significant differences in ECMO running time, 30-day survival rate, and the incidence of death related complications between the two groups.
Conclusion: PCRTO protocol is a safe and effective weaning strategy for VA-ECMO patients, which can improve the success rate of weaning, reduce the incidence of CS after weaning and thrombotic events during the weaning trial. |
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