杨政乐,徐承义,易东,徐晓蝶,宋丹,罗婷,鄢华

• 1:武汉科技大学附属武汉亚洲心脏病医院心内科
• 2:武汉科技大学医学部医学院

摘要(Abstract)：

静脉-动脉体外膜肺氧合技术是一种可以减少接受高危复杂的经皮冠状动脉介入治疗患者围术期发生心原性休克等不良事件的有效手段。国内常规静脉-动脉体外膜肺氧合技术路径的选择主要是股动脉和股静脉，而通过腋动脉路径进行体外膜肺氧合置管的病例较为少见。但在国外，腋动脉插管静脉-动脉体外膜肺氧合循环辅助模式已被视为治疗危重症患者的常规临床路径之一。本病例报道1例老年男性患者因股动脉入路困难，而选择右侧腋动脉路径置入体外膜肺氧合辅助循环，进行高危复杂的经皮冠状动脉介入治疗，并最终救治成功的案例。以期为临床行体外膜肺氧合技术路径的选择提供借鉴。

关键词(KeyWords)： 腋动脉;体外膜肺氧合;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation): 湖北省卫生厅科研项目（QJX2012-35）

作者(Author): 杨政乐,徐承义,易东,徐晓蝶,宋丹,罗婷,鄢华

参考文献(References)：

• [1]孟丽，刘闯，李杏杏，等.预置股动静脉鞘管体外膜肺氧合床旁备机在高危经皮冠状动脉介入治疗中应用的可行性分析[J].中国循环杂志，2023,38(1):49-52.DOI:10.3969/j.issn.1000-3614.2023.01.004.
• [2]郭锋伟，张颖，王雪，等.股静脉-股动脉体外膜氧合发生差异性缺氧的原因及处理策略[J].中国体外循环杂志，2022,20(6):371-376.DOI:10.13498/j.cnki.chin.j.ecc.2022.06.11.
• [3]Ohira S,Malekan R,Goldberg JB,et al.Axillary artery cannulation for veno-arterial extracorporeal membrane oxygenation support in cardiogenic shock[J].JTCVS Tech,2020,5:62-71.DOI:10.1016/j.xjtc.2020.10.035.
• [4]郭锋伟，刘锋锋，钟亮，等.腋动脉插管VA-ECMO在救治危重患者中的效果分析[J].中国临床研究，2023,36(10):1555-1558.DOI:10.13429/j.cnki.cjcr.2023.10.023.
• [5]Sabik JF,Nemeh H,Lytle BW,et al.Cannulation of the axillary artery with a side graft reduces morbidity[J].Ann Thorac Surg,2004,77(4):1315-1320.DOI:10.1016/j.athoracsur.2003.08.056.
• [6]Chamogeorgakis T,Lima B,Shafii AE,et al.Outcomes of axillary artery side graft cannulation for extracorporeal membrane oxygenation[J].J Thorac Cardiovasc Surg,2013,145(4):1088-1092.DOI:10.1016/j.jtcvs.2012.08.070.
• [7]Moazami N,Moon MR,Lawton JS,et al.Axillary artery cannulation for extracorporeal membrane oxygenator support in adults:an approach to minimize complications[J].J Thorac Cardiovasc Surg,2003,126(6):2097-2098.DOI:10.1016/s0022-5223(03)00965-6.
• [8]Xie Y,Liu Y,Yang P,et al.Comparison of post-operative outcomes between direct axillary artery cannulation and sidegraft axillary artery cannulation in cardiac surgery:a systematic review and meta-analysis[J].Front Cardiovasc Med,2022,9:925709.DOI:10.3389/fcvm.2022.925709.
• [9]Hysi I,Fabre O,Renaut C,et al.Extracorporeal membrane oxygenation with direct axillary artery perfusion[J].J Card Surg,2014,29(2):268-269.DOI:10.1111/jocs.12229.
• [10]Papadopoulos N,Ahmad Ael-S,Marinos S,et al.Simple and controlled method to avoid hyperperfusion of the right arm following axillary artery cannulation for extracorporeal membrane oxygenator support[J].Thorac Cardiovasc Surg,2013,61(7):581-583.DOI:10.1055/s-0032-1327763.
• [11]Omer S,Rajagopal K.Commentary:when preserving life,do not neglect the limb:the role of axillary artery cannulation in venoarterial extracorporeal membrane oxygenation[J].JTCVSTech,2020,5:72-73.DOI:10.1016/j.xjtc.2020.11.026.
• [12]Wang J,Wang S,Song Y,et al.The preventive effect of distal perfusion catheters on vascular complications in patients undergoing venous artery extracorporeal membrane oxygenation[J].J Multidiscip Healthc,2023,16:963-970.DOI:10.2147/JMDH.S398704.
• [13]Pisani A,Braham W,Brega C,et al.Right axillary artery cannulation for venoarterial extracorporeal membrane oxygenation:a retrospective single centre observational study[J].Eur J Cardiothorac Surg,2021,59(3):601-609.DOI:10.1093/ejcts/ezaa397.
• [14]Ohira S,Dhand A,Hirani R,et al.Cannulation‐related adverse events of peripheral veno‐arterial extracorporeal membrane oxygenation support in heart transplantation:axillary versus femoral artery cannulation[J].Clin Transplant,2023,37(3):e14871.DOI:10.1111/ctr.14871.
• [15]Bonicolini E,Martucci G,Simons J,et al.Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation:a narrative review of incidence,prevention,monitoring,and treatment[J].Crit Care,2019,23(1):266.DOI:10.1186/s13054-019-2541-3.
• [16]Roussel A,Al-Attar N,Khaliel F,et al.Arterial vascular complications in peripheral extracorporeal membrane oxygenation support:a review of techniques and outcomes[J].Future Cardiol,2013,9(4):489-495.DOI:10.2217/fca.13.34.
• [17]于坤，龙村，黑飞龙，等.体外膜肺氧合结合左心减压治疗心脏术后重症心衰[J].中国体外循环杂志，2010,8(1):21-24.DOI:10.3969/j.issn.1672-1403.2010.01.008.
• [18]Russo G,Burzotta F,Aurigemma C,et al.Can we have a rationalized selection of intra-aortic balloon pump,Impella,and extracorporeal membrane oxygenation in the catheterization laboratory?[J].Cardiol J,2022,29(1):115-132.DOI:10.5603/CJ.a2020.0182.
• [19]Javidfar J,Brodie D,Costa J,et al.Subclavian artery cannulation for venoarterial extracorporeal membrane oxygenation[J].ASAIO J,2012,58(5):494-498.DOI:10.1097/MAT.0b013e318268ea15.
• [20]Rupprecht L,Fl?rchinger B,Schopka S,et al.Cardiac decompression on extracorporeal life support[J].ASAIO J,2013,59(6):547-553.DOI:10.1097/MAT.0b013e3182a4b2f6.
• [21]Radwan M,Baghdadi K,Popov AF,et al.Right axillary artery cannulation for veno-arterial extracorporeal membrane oxygenation in postcardiotomy patients:a single-center experience[J].Medicina(Kaunas),2023,59(11):2040.DOI:10.3390/medicina59112040.
• [22]Nuding S,Werdan K.IABP plus ECMO-is one and one more than two?[J].J Thorac Dis,2017,9(4):961-964.DOI:10.21037/jtd.2017.03.73.