成人体外膜肺氧合的应用及并发症Application and complications of extracorporeal membrane oxygenation in adults
何立芸;牛杰;
摘要(Abstract):
体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)是近年来应用越来越广泛的一种体外心肺机械辅助技术,用于常规治疗无效的循环衰竭和(或)呼吸衰竭的辅助治疗,可有效降低患者死亡率。但受患者自身疾病及ECMO本身技术特点所限,使用ECMO辅助的患者面临着多种并发症发生的可能,包括患者机体并发症(如出血、栓塞、末端肢体缺血、溶血、神经系统功能异常、肾功能不全及感染等)和ECMO机械系统并发症(如氧合器氧合不良、血浆渗漏、循环管道破裂等),并发症的出现将显著影响患者预后,应予以高度重视。
关键词(KeyWords): 体外膜肺氧合;成人;并发症
基金项目(Foundation): 国家自然科学基金(81500267)
作者(Authors): 何立芸;牛杰;
参考文献(References):
- [1]Karagiannidis C,Brodie D,Strassmann S,et al.Extracorporeal membrane oxygenation:evolving epidemiology and mortality[J].Intensive Care Med,2016,42(5):889-896.
- [2]O'Rourke PP,Stolar CJ,Zwischenberger JB,et al.Extracorporeal membrane oxygenation:support for overwhe lming pulm onary failure in the pediatric population.Collective experience from the extracorporeal life support organization[J].JPediatr Surg,1993,28(4):523-528.
- [3]Zangrillo A,Landoni G,Biondi-Zoccai G,et al.A meta-analysis of complications and mortality of extracorporeal membrane oxygenation[J].Crit Care Resusc,2013,15(3):172-178.
- [4]高国栋,黑飞龙,吉冰洋,等.128例成人体外膜肺氧合支持治疗患者相关并发症回顾分析[J].中国分子心脏病学杂志,2015,15(1):1197-1201.
- [5]Lim MW.The history of extracorporeal oxygenators[J].Anaesthesia,2006,61(10):984-995.
- [6]Bartlett RH,Roloff DW,Cornell RG,et al.Extracorporeal circulation in neonatal respiratory failure:a prospective randomized study[J].Pediatrics,1985,76(4):479-487.
- [7]中国医师协会体外生命支持专业委员会.成人体外膜氧合循环辅助专家共识[J].中华医学杂志,2018,98(12):886-894.
- [8]Guglin M,Zucker MJ,Bazan VM,et al.Venoarterial ECMOfor Adults:JACC Scientific Expert Panel[J].J Am Coll Cardiol,2019,73(6):698-716.
- [9]Nasr VG,Raman L,Barbaro RP,et al.Highlights from the extracorporeal life support organization registry:2006-2017[J].ASAIO J,2018.[Epub ahead of print]
- [10]朱德明.2012年中国心脏外科和体外循环数据白皮书[J].中国体外循环杂志,2013,11(4):193.
- [11]朱德明,龙村,黑飞龙.2013中国心脏外科和体外循环数据白皮书[J].中国体外循环杂志,2014,12(3):129-131.
- [12]朱德明,龙村,黑飞龙.2014中国心脏外科和体外循环数据白皮书[J].中国体外循环杂志,2015,13(3):129-131.
- [13]赵举,黑飞龙.2015中国心脏外科和体外循环数据白皮书[J].中国体外循环杂志,2016,14(3):130-132.
- [14]黑飞龙,朱德明,侯晓彤,等.2016年中国心脏外科手术和体外循环数据白皮书[J].中国体外循环杂志,2017,15(2):65-67.
- [15]Burkhoff D,Sayer G,Doshi D,et al.Hemodynamics of mechanical circulatory support[J].J Am Coll Cardiol,2015,66(23):2663-2674.
- [16]Ostadal P,Mlcek M,Kruger A,et al.Increasing venoarterial extracorporeal membrane oxygenation flow negatively affects left ventricular performance in a porcine model of cardiogenic shock[J].J Transl Med,2015,13:266.
- [17]Meani P,Gelsomino S,Natour E,et al.Modalities and effects of left ventricle unloading on extracorporeal life support:a review of the current literature[J].Eur J Heart Fail,2017,19Suppl 2:84-91.
- [18]Extracorporeal Life Support Organization(ELSO).Guidelines for adult respiratory failure,version 1.4 August 2017[EB/OL].https://www.elso.org/Portals/0/ELSO%20Guidelines%20For%20Adult%20Respiratory%20Failure%201_4.pdf.
- [19]Paden ML,Rycus PT,Thiagarajan RR,et al.Update and outcomes in extracorporeal life support[J].Semin Perinatol,2014,38(2):65-70.
- [20]Vaquer S,de Haro C,Peruga P,et al.Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome[J].Ann Intensive Care,2017,7(1):51.
- [21]Murphy DA,Hockings LE,Andrews RK,et al.Extracorporeal membrane oxygenation-hemostatic complications[J].Transfus Med Rev,2015,29(2):90-101.
- [22]Rastan AJ,Lachmann N,Walther T,et al.Autopsy findings in patients on postcardiotomy extracorporeal membrane oxygenation(ECMO)[J].Int J Artif Organs,2006,29(12):1121-1131.
- [23]Lubnow M,Philipp A,Dornia C,et al.D-dimers as an early marker for oxygenator exchange in extracorporeal membrane oxygenation[J].J Crit Care,2014,29(3):473 e1-5.
- [24]Dornia C,Philipp A,Bauer S,et al.D-dimers are a predictor of clot volume inside membrane oxygenators during extracorp oreal membrane oxygenation[J].Artif Organs,2015,39(9):782-787.
- [25]Thomas J,Kostousov V,Teruya J.Bleeding and thrombotic complications in the use of extracorporeal membrane oxygenation[J].Semin Thromb Hemost,2018,44(1):20-29.
- [26]Balle CM,Jeppesen AN,Christensen S,et al.Platelet function during extracorporeal membrane oxygenation in adult patients:a systematic review[J].Front Cardiovasc Med,2018,5:157.
- [27]Kalbhenn J,Schlagenhauf A,Rosenfelder S,et al.Acquired von willebrand syndrome and impaired platelet function during venovenous extracorporeal membrane oxygenation:Rapid onset and fast recovery[J].J Heart Lung Transplant,2018,37(8):985-991.
- [28]Extracorporeal Life Support Organization(ELSO).General guidelines for all ECLS cases,version 1.4.August 2017[EB/OL].https://www.elso.org/Portals/0/ELSO%20Guidelines%20General%20All%20ECLS%20Version%201_4.pdf.
- [29]Chung YS,Cho DY,Sohn DS,et al.Is stopping heparin safe in patients on extracorporeal membrane oxygenation treatment?[J].ASAIO J,2017,63(1):32-36.
- [30]Cheng R,Hachamovitch R,Kittleson M,et al.Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest:a meta-analysis of 1,866adult patients[J].Ann Thorac Surg,2014,97(2):610-616.
- [31]Juo YY,Skancke M,Sanaiha Y,et al.Efficacy of distal perfusion cannulae in preventing limb ischemia during extracorporeal membrane oxygenation:a systematic review and meta-analysis[J].Artif Organs,2017,41(11):E263-E273.
- [32]Lorusso R,Gelsomino S,Parise O,et al.Neurologic injury in adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure:findings from the extracorporeal life support organization database[J].Crit Care Med,2017,45(8):1389-1397.
- [33]Lorusso R,Barili F,Mauro MD,et al.In-Hospital Neurologic Complications in Adult Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation:Results From the Extracorporeal Life Support Organization Registry[J].Crit Care Med,2016,44(10):e964-e972.
- [34]Liao X,Cheng Z,Wang L,et al.Analysis of the risk factors of acute kidney injury in patients receiving extracorporeal membrane oxygenation[J].Clin Nephrol,2018,90(4):270-275.
- [35]Lin CY,Chen YC,Tsai FC,et al.Rifle classification is predictive of short-term prognosis in critically ill patients with acute renal failure supported by extracorporeal membrane oxygenation[J].Nephrol Dial Transplant,2006,21(10):2867-2873.
- [36]Yan X,Jia S,Meng X,et al.Acute kidney injury in adult postcar diotomy patients with extracorporeal membrane oxygeation:evaluation of the rifle classification and the acute kidney injury network criteria[J].Eur J Cardiothorac Surg,2010,37(2):334-338.
- [37]Chen YC,Tsai FC,Fang JT,et al.Acute kidney injury in adults receiving extracorporeal membrane oxygenation[J].J Formos Med Assoc,2014,113(11):778-785.
- [38]Devasagayaraj R,Cavarocchi NC,Hirose H.Does acute kidney injury affect survival in adults with acute respiratory distress syndrome requiring extracorporeal membrane oxygenation?[J].Perfusion,2018,33(5):375-382.
- [39]边帆,戚宇岸,葛勤敏.体外膜肺氧合相关急性肾损伤研究进展[J].国际泌尿系统杂志,2017,37(4):638-640.
- [40]Fleming GM,Askenazi DJ,Bridges BC,et al.A multicenter international survey of renal supportive therapy during ECMO:the kidney intervention during extracorporeal membrane oxygenation(kidmo)group[J].ASAIO J,2012,58(4):407-414.
- [41]Askenazi DJ,Selewski DT,Paden ML,et al.Renal replacement therapy in critically ill patients receiving extracorporeal memb rane oxygenation[J].Clin J Am Soc Nephrol,2012,7(8):1328-1336.
- [42]Chen H,Yu RG,Yin NN,et al.Combination of extracorporeal membrane oxygenation and continuous renal replacement therapy in critically ill patients:A systematic review[J].Crit Care,2014,18(6):675.
- [43]Menaker J,Galvagno S,Rabinowitz R,et al.Epidemiology of blood stream infection in adult extracorporeal membrane oxygenation patients:a cohort study[J].Heart Lung,2019.[Epub ahead of print]
- [44]Li B,Sun G,Cheng Z,et al.Analysis of nosocomial infections in post-cardiac surgery extracorporeal membrane oxygenation support therapy[J].Heart Surg Forum,2018,21(5):E387-E391.
- [45]Sun G,Li B,Lan H,et al.Risk factors for nosocomial infections in patients receiving extracorporeal membrane oxygenation supportive therapy[J].Med Clin(Barc),2017,149(10):423-428.
- [46]Biffi S,Di Bella S,Scaravilli V,et al.Infections during extracorporeal membrane oxygenation:Epidemiology,risk factors,pathogenesis and prevention[J].Int J Antimicrob Agents,2017,50(1):9-16.
- [47]Vercaemst L.Hemolysis in cardiac surgery patients undergoing cardiopulmonary bypass:a review in search of a treatment algorithm[J].J Extra Corpor Technol,2008,40(4):257-267.
- [48]Hei F,Lou S,Li J,et al.Five-year results of 121 consecutive patients treated with extracorporeal membrane oxygenation at fu wai hospital[J].Artif Organs,2011,35(6):572-578.
- [49]Agati S,Ciccarello G,Fachile N,et al.DIDECMO:a new polymethylpentene oxygenator for pediatric extracorporeal membrane oxygenation[J].ASAIO J,2006,52(5):509-512.