体外膜肺氧合辅助下急性呼吸窘迫综合征俯卧位通气策略  

Strategies of prone ventilation for acute respiratory stress syndrome assisted by extracorporeal membrane oxygenation

作　　者：陈震[1] 田家豪 王义[1] CHEN Zhen;TIAN Jia-hao;WANG Yi(The Pediatric Intensive Care Unit of the Childrens Hospital Affiliated to Xi'an Jiaotong University,Xian 710003,China;不详)

机构地区：[1]西安交通大学附属儿童医院儿童重症医学科,陕西西安710003 [2]西安交通大学医学部基础医学院,陕西西安710061

出　　处：《中国实用儿科杂志》2022年第3期185-189,共5页Chinese Journal of Practical Pediatrics

基　　金：陕西省科技厅-自然科学基础研究计划面上项目(2021JM560);西安市科技局西安市创新能力强基计划-医学研究项目(21YXYJ0009);西安市儿童医院院级科研项目(2020C15)。

摘　　要：静脉-静脉体外膜肺氧合(veno-venous extracorporeal membrane oxygenation, VV-ECMO)可以改善难治性低氧血症和(或)高碳酸血症急性呼吸窘迫综合征(ARDS)患者气体交换,从而使肺“休息”,并降低呼吸机诱导的肺损伤,常用于重度ARDS抢救治疗。俯卧位(prone positioning, PP)可改善中重度ARDS患者氧合、降低病死率,并被指南所推荐。对于俯卧位在VV-ECMO辅助期间的临床研究相对较少,缺少相关经验,VV-ECMO辅助期间患者往往处于仰卧位(supine position, SP)。近年来,越来越多的证据表明VV-ECMO辅助期间俯卧位可改善重度ARDS患者氧合、清除二氧化碳及改善呼吸系统顺应性,且无重大不良事件。该文结合相关文献证据对VV-ECMO辅助期间应用俯卧位进行相关综述。Veno-venous Extracorporeal membrane oxygenation(VV-ECMO) is commonly used in the treatment of severe ARDS. It improves gas exchange, “rests” the lungs, and reduces ventilator-induced lung injury in ARDS patients with refractory hypoxemia and/or hypercapnia. Prone positioning(PP) is recommended by the guidelines for improving oxygenation and reducing mortality in moderate-to-severe ARDS patients. Due to the lack of clinical research evidence and relevant experience associated with prone positioning during extracorporeal support, patients on VV-ECMO support have historically been managed in supine position. Recently, a number of studies have reported the feasibility of PP during VV-ECMO assistance, which is associated with an improvement of oxygenation, CO;clearance and respiratory system compliance. This paper reviews the research progress of PP application during VV-ECMO assistance by collecting relevant research evidence.

关 键 词：体外膜肺氧合 急性呼吸窘迫综合征 俯卧位通气 儿童 

分 类 号：R72[医药卫生—儿科]