中国成人经股动脉VA-ECMO治疗期间下肢缺血防治专家共识（2023）

中华危重病急救医学2023年8月第35卷第8期Chin Crit Care Med,August2023,Val.35,No.8·785·专家共识·中国成人经股动脉VA-ECMO治疗期间下肢缺血防治专家共识（2023)中国医师协会体外生命支持专业委员会山东省医师协会体外生命支持专业委员会通信作者：邢金燕，青岛大学附属医院重症医学科，山东青岛266003，Email:xingjy(@qdu.ed血.cm【摘要】静脉-动脉体外膜肺氧合(VA-ECMO)是重度循环衰竭患者重要的救治技术，其应用也越来越广泛。经股动脉置管简单便捷，成为成人VA-ECMO最常用的置管方式。下肢缺血是经股动脉VA-ECMO治疗过程中的常见并发症，一旦发生将严重影响患者预后及生存质量。为了规范VA-ECMO治疗期间下肢缺血1的管理，降低致残率及病死率，中国医师协会体外生命支持专业委员会和山东省医师协会体外生命支持专业委员会特组织国内具有ECMO熟练使用经验的多学科医学专家，基于文献回顾和临床实践经验制定了《中国成人经股动脉VA-ECMO治疗期间下肢缺血防治专家共识(2023)》，以期为经股动脉VA-ECMO治疗期间下肢缺血的预防、监测及治疗提供有价值的参考。【关键词】静脉动脉体外膜肺氧合；下肢缺血；专家共识实践指南注册：国际实践指南注册与透明化平台，PREPARE-2022CN631D0I:10.3760/cmaj.cn121430-20230426-00323Expert consensus on prevention and treatment of lower limb ischemia during transfemoral veno-arterialextracorporeal membrane oxygenation therapy in adults in China (2023)Extracorporeal Life Support Professional Committee of Chinese Medical Doctor Association,Extracorporeal Life SupportProfessional Committee of Shandong Physician AssociationCorresponding author:Xing Jinyan,Department of Critical Care Medicine,the Affiliated Hospital of Qingdao University,Qingdao 266003,Shandong,China,Email:xingiy@qdu.edu.cn[Abstract]Veno-arterial extracorporeal membrane oxygenation (VA-ECMO)is an important technique for thetreatment of patients with severe circulatory failure,and is used in a wider range.Canulation through the femoral arteryis simple and convenient,which has become the most commonly used canulation method of VA-ECMO for adults.Lowerlimb ischemia is a common complication in transfemoral VA-ECMO therapy,which will seriously affect the prognosisand quality of life of patients.In order to standardize the lower limb ischemia management during VA-ECMO treatmentand reduce disability and mortality,Extracorporeal Life Support Professional Committee of Chinese Medical DoctorAssociation and Extracorporeal Life Support Professional Committee of Shandong Physician Association organizedmultidisciplinary medical experts with ECMO proficiency from China to develop the Expert consensus on prerentionand treatment of lower limb ischemia during transfemoral reno-arterial extracorporeal membrane oxygenation therapyin adults in China (2023),based on literature review and their clinical practice experience.This consensus is expectedto provide valuable reference for the prevention,monitoring and treatment of lower limb ischemia during femoral arteryVA-ECMO treatment.[Key words]Veno-arterial extracorporeal membrane oxygenation;Lower limb ischemia;Expert consensusPractice guideline registration:Practice Guideline Registration for Transparency,PREPARE-2022CN631D0:10.3760Wcma.j.cm121430-20230426-00323静脉-动脉体外膜肺氧合(veno-arterial extracorporeal施，成为成人VA-ECM0最常用的置管方式[-o]membrane oxygenation,VA-ECMO)是一种有效的机然而，接受VA-ECMO治疗的患者因本身血流动械性循环支持方式，其将部分静脉血从患者体内引力学不稳定及逆行动脉插管会导致同侧动脉血流减流至体外，经氧合器氧合后再由驱动泵泵入动脉系少甚至中断，容易造成下肢缺血：大剂量血管活性药统，可为各种原因导致的常规治疗无效的循环衰竭患物的使用、血流缓慢和内皮损伤等因素导致下肢血者提供数天或数周，甚至数月的持续循环支持®2]。栓形成及下肢远端灌注管(distal perfusion catheter,.随着生物材料改良和技术进步，VA-ECMO适应证不DPC)堵塞等，也会造成或加重下肢缺血[断扩