Study of Lower Extremity Ischemia During PCPS Support

Although percutaneous cardioplumonary support (PCPS) is effective as an emergency measure for circulatory collapse, lower extremity ischemia and myonephrotic metabolic syndrome is still considered to be its major lethal side effect. Twenty-six consecutive patients who necessitated PCPS support were...

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Published inJinko Zoki Vol. 29; no. 2; pp. 345 - 350
Main Authors Satou, M, Endou, H, Fujiki, T, Ide, H, Sudou, K
Format Journal Article
LanguageJapanese
Published JAPANESE SOCIETY FOR ARTIFICIAL ORGANS 2000
一般社団法人 日本人工臓器学会
Subjects
Lower extremity ischemia
PCPS
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ISSN0300-0818
1883-6097
DOI10.11392/jsao1972.29.345

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Abstract Although percutaneous cardioplumonary support (PCPS) is effective as an emergency measure for circulatory collapse, lower extremity ischemia and myonephrotic metabolic syndrome is still considered to be its major lethal side effect. Twenty-six consecutive patients who necessitated PCPS support were enrolled in this study. Seven patients (27%) were found clinically to have lower extremity ischemia of the cannulated side, of whom two patients died of myonephro metabolic syndrome. Regard' to their basal disease, 50% of the patients with ischemic heart disease are shown to have lower extremity ischemia, and 7% of those are without ischemic heart disease, showing a significant difference. As for plasma enzymal analysis, plasma CPK level is shown to be a significant index for exclusively evaluating lower extremity ischemia. Concomitant extremity perfusion of the PCPS cannulated side using a 14G needle is found to be effective for preventing lower extremity ischemia.
AbstractList Although percutaneous cardioplumonary support (PCPS) is effective as an emergency measure for circulatory collapse, lower extremity ischemia and myonephrotic metabolic syndrome is still considered to be its major lethal side effect. Twenty-six consecutive patients who necessitated PCPS support were enrolled in this study. Seven patients (27%) were found clinically to have lower extremity ischemia of the cannulated side, of whom two patients died of myonephro metabolic syndrome. Regard' to their basal disease, 50% of the patients with ischemic heart disease are shown to have lower extremity ischemia, and 7% of those are without ischemic heart disease, showing a significant difference. As for plasma enzymal analysis, plasma CPK level is shown to be a significant index for exclusively evaluating lower extremity ischemia. Concomitant extremity perfusion of the PCPS cannulated side using a 14G needle is found to be effective for preventing lower extremity ischemia. 経皮的心肺補助 (PCPS) は簡便かつ迅速に導入可能であり, 緊急を要する急性循環不全に対する有用性が報告されているが, その緊急性からASOの合併は挿入前に未評価のことが多く, 下肢虚血からMyonephoroticmetabolic syndrome (MNMS) を併発し致命的となった症例も経験している。今回緊急にPCPSを導入した26例の下肢虚血について検討した。合併症としての下肢虚血の頻度は全体の27%, 死亡例では基礎疾患以外の死亡原因の約30%を占めており重要な合併症であることが示唆された。非虚血性心疾患での下肢虚血の合併頻度が7%であるのに対し, 虚血性心疾患では50%と有意な関連性を認めた。下肢虚血例での酵素系の検討ではCPKが有意に上昇を認め, 下肢虚血の評価に有用であると思われた。静脈点滴用留置針による下肢送血を行った症例では下肢虚血の理学所見, 血清逸脱酵素の上昇共に認めず, その対処法として有効であった。
Although percutaneous cardioplumonary support (PCPS) is effective as an emergency measure for circulatory collapse, lower extremity ischemia and myonephrotic metabolic syndrome is still considered to be its major lethal side effect. Twenty-six consecutive patients who necessitated PCPS support were enrolled in this study. Seven patients (27%) were found clinically to have lower extremity ischemia of the cannulated side, of whom two patients died of myonephro metabolic syndrome. Regard' to their basal disease, 50% of the patients with ischemic heart disease are shown to have lower extremity ischemia, and 7% of those are without ischemic heart disease, showing a significant difference. As for plasma enzymal analysis, plasma CPK level is shown to be a significant index for exclusively evaluating lower extremity ischemia. Concomitant extremity perfusion of the PCPS cannulated side using a 14G needle is found to be effective for preventing lower extremity ischemia.
Author Fujiki, T
Ide, H
Endou, H
Sudou, K
Satou, M
Author_FL 佐藤 政弥
井手 博文
遠藤 英仁
須藤 憲一
藤木 達雄
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References 7) 堺正仁, 樗木等, 土井一義ほか: 経皮的心肺補助装置の臨床応用-現状と問題点-. 日救急医会誌7: 345-351, 1969
9) Muehrcke DD, McCarthy PM, Stewart RW, Seshagiri S, Ogella DA, Foster RC, Cosgrove DM: Complication of extracorporeal life support systems using heparin-bound surfaces. J Thorac Cardiovasc Surg 110: 843-851, 1995
10) 山西秀樹, 渡辺直, 林和秀: 開心術後の体外循環離脱困難症例に対する長時間PCPS (経皮的補助循環法) 使用における心嚢血腫確認の必要性と下肢虚血防止の工夫-5例の経験から-. 日胸外会誌43: 1783-87, 1995
6) Shigeyuki Sasaki, MD*, Keishu Matsui Y, Aoi K, Gando S, Kenmotsu O: Therapeutic strategy of perioperative use of percutaneous cardiopulmonary bypass support (PCPS) foradult cardiac surgery. JPn J Thoracic Cardiovasc Surg 47: 20-26, 1999
8) 古川浩二郎, 樗木等, 堺正仁, 土井一義, 成田安志: 開心術後人工心肺離脱困難症例に対する経皮的体外循環装置 (PCPS) の有用性と問題点. 胸部外科51: 981-985, 1998
5) 湊谷謙司, 岡林均, 嶋田一郎, 大野暢久, 仁科健, 亀山敬幸: PCPSを使用した急性心筋梗塞後自由壁破裂 (blow-out型) の1手術例. 日胸外会誌43: 398-401, 1995
2) 宮本裕治, 松田輝, 南野隆三: 本邦における経皮的心肺補助療法の使用状況一全国集計報告-. ICUとCCU18: 939-943, 1994
4) 正井崇史, 榊原哲夫, 渡辺真一郎, 児玉和久, 金香充範, 松田暉: 経皮的心肺補助システムによる循環補助の後に外科治療に成功した急性心筋梗塞後左室自由壁破裂 (blow outtype) の1例. 日胸外会誌40: 86-90, 1992
3) Sudo K, Ide H, Fujiki T, Tonari K, Nasu Y, Ikeda K: Pulmonaryembolectomy for acute massive pulmonary embolism under percutaneous cardiopulmonary support: The J Cardiovasc Surg 40: 165-167, 1999
1) Phillips SJ, Ballentine B, Slonine D, Hall J, Vandehaar J, Kongtahworn C, Zeff RH, Skinner JR, Reckmo K, Gray D: Percutaneous initiation of cardiopulmonary bypass. Ann Thorac Surg 36: 223-235, 1983
11) 合田俊宏, 朝田政克, 佐々木重幸, 郷一知, 松井喜郎, 佐久間まこと, 安田慶秀, 田辺達三: 左心補助とV-Aバイパスにおける遠心ポンプの臨床応用. 人工臓器21: 439-443, 1992
References_xml – reference: 7) 堺正仁, 樗木等, 土井一義ほか: 経皮的心肺補助装置の臨床応用-現状と問題点-. 日救急医会誌7: 345-351, 1969
– reference: 4) 正井崇史, 榊原哲夫, 渡辺真一郎, 児玉和久, 金香充範, 松田暉: 経皮的心肺補助システムによる循環補助の後に外科治療に成功した急性心筋梗塞後左室自由壁破裂 (blow outtype) の1例. 日胸外会誌40: 86-90, 1992
– reference: 10) 山西秀樹, 渡辺直, 林和秀: 開心術後の体外循環離脱困難症例に対する長時間PCPS (経皮的補助循環法) 使用における心嚢血腫確認の必要性と下肢虚血防止の工夫-5例の経験から-. 日胸外会誌43: 1783-87, 1995
– reference: 11) 合田俊宏, 朝田政克, 佐々木重幸, 郷一知, 松井喜郎, 佐久間まこと, 安田慶秀, 田辺達三: 左心補助とV-Aバイパスにおける遠心ポンプの臨床応用. 人工臓器21: 439-443, 1992
– reference: 2) 宮本裕治, 松田輝, 南野隆三: 本邦における経皮的心肺補助療法の使用状況一全国集計報告-. ICUとCCU18: 939-943, 1994
– reference: 1) Phillips SJ, Ballentine B, Slonine D, Hall J, Vandehaar J, Kongtahworn C, Zeff RH, Skinner JR, Reckmo K, Gray D: Percutaneous initiation of cardiopulmonary bypass. Ann Thorac Surg 36: 223-235, 1983
– reference: 3) Sudo K, Ide H, Fujiki T, Tonari K, Nasu Y, Ikeda K: Pulmonaryembolectomy for acute massive pulmonary embolism under percutaneous cardiopulmonary support: The J Cardiovasc Surg 40: 165-167, 1999
– reference: 5) 湊谷謙司, 岡林均, 嶋田一郎, 大野暢久, 仁科健, 亀山敬幸: PCPSを使用した急性心筋梗塞後自由壁破裂 (blow-out型) の1手術例. 日胸外会誌43: 398-401, 1995
– reference: 8) 古川浩二郎, 樗木等, 堺正仁, 土井一義, 成田安志: 開心術後人工心肺離脱困難症例に対する経皮的体外循環装置 (PCPS) の有用性と問題点. 胸部外科51: 981-985, 1998
– reference: 6) Shigeyuki Sasaki, MD*, Keishu Matsui Y, Aoi K, Gando S, Kenmotsu O: Therapeutic strategy of perioperative use of percutaneous cardiopulmonary bypass support (PCPS) foradult cardiac surgery. JPn J Thoracic Cardiovasc Surg 47: 20-26, 1999
– reference: 9) Muehrcke DD, McCarthy PM, Stewart RW, Seshagiri S, Ogella DA, Foster RC, Cosgrove DM: Complication of extracorporeal life support systems using heparin-bound surfaces. J Thorac Cardiovasc Surg 110: 843-851, 1995
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Snippet Although percutaneous cardioplumonary support (PCPS) is effective as an emergency measure for circulatory collapse, lower extremity ischemia and myonephrotic...
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SubjectTerms Lower extremity ischemia
PCPS
Title Study of Lower Extremity Ischemia During PCPS Support
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