静脉‑静脉体外膜肺氧合上机时机的探讨  

Timing of starting veno‑venous extracorporeal membrane oxygenation

作　　者：崔晓倩[1] 田加坤[1] 张敏[1] 田振玮 顾明[1] 张京晓[1] 赖冰洁[1] 尹永杰[1] Cui Xiaoqian;Tian Jiakun;Zhang Min;Tian Zhenwei;Gu Ming;Zhang Jingxiao;Lai Bingjie;Yin Yongjie(Department of Emergency and Critical Care,the Second Hospital of Jilin University,Changchun 130041,China)

机构地区：[1]吉林大学第二医院急诊与重症医学科,长春130041

出　　处：《中华医学杂志》2022年第25期1887-1890,共4页National Medical Journal of China

基　　金：吉林省医疗卫生人才专项(2019SCZT022)。

摘　　要：静脉-静脉体外膜肺氧合(VV-ECMO)目前主要用于常规措施难以纠正的急性呼吸衰竭,且这种导致呼吸衰竭的病因是可逆的,或是为肺移植提供桥接手段。急性呼吸窘迫综合征(ARDS)是急性呼吸衰竭中的典型的临床综合征。重症ARDS患者VV-ECMO上机的时机仍面临诸多的争议和挑战,本文从机械通气参数优化、呼吸动力学及血流动力学监测、肺可复张性评估以及电阻抗成像(EIT)实时监测等方面,对目前可行的上机前评估手段进行汇总探讨。Veno-venous extracorporeal membrane oxygenation(VV-ECMO)is mainly used for reversible acute respiratory failure that is difficult to correct with mechanical ventilation and other conventional measures or preparation of lung transplantation.Acute respiratory distress syndrome(ARDS)is a typical clinical syndrome of acute respiratory failure.The timing of starting VV-ECMO in severe ARDS still face many controversies and challenges.This paper we discuss the current feasible assessment methods of when to start VV-ECMO in ARDS,such as,optimization of mechanical ventilation parameters,monitoring of respiratory dynamics and hemodynamics,assessment of lung recruitability and electrical impedance tomography(EIT)real-time monitoring,etc.

关 键 词：体外膜氧合作用 急性呼吸窘迫综合征 静脉‑静脉体外膜肺氧合 上机时机 机械通气 

分 类 号：R563.8[医药卫生—呼吸系统]