我国院前体外心肺复苏的实践现状及其预后危险因素和管理对策  

Current practice,prognostic risk factors and management strategies of pre-hospital extracorporeal cardiopulmonary resuscitation in China

作　　者：周亮亮 陈建军 吴婧 邓义军 丁仁彧[2] Zhou Liangliang;Chen Jianjun;Wu Jing;Deng Yijun;Ding Renyu(Department of Emergency Intensive Care Unit,Yancheng First People's Hospital,Yancheng 224000,Jiangsu,China;Department of Critical Care Medicine,the First Affiliated Hospital of China Medical University,Shenyang 110000,Liaoning,China)

机构地区：[1]盐城市第一人民医院急诊医学科危重症监护病区,江苏盐城224000 [2]中国医科大学附属第一医院重症医学科,辽宁沈阳110000

出　　处：《中华危重病急救医学》2025年第2期103-110,共8页Chinese Critical Care Medicine

基　　金：江苏省盐城市卫生健康委员会医科科研项目(PC20230805004)。

摘　　要：随着体外膜肺氧合(ECMO)的逐步开展和普及,我国部分地级市医疗机构开展并形成了自身的院前体外心肺复苏(ECPR)模式。尽管各地级市发展水平不一,开展时间有先后,但大致都会经历ECMO—院内ECPR—院前ECPR—专业医学复苏中心的发展历程,其中院内ECPR由于复苏及时、复苏质量有保证,ECPR团队启动速度快等优点,目前成功率高,患者遗留神经系统并发症的比例低;而院前ECPR难度更大,由于需要院前-院内急救力量联动、多学科协作、ECPR启动前复苏质量无法得到充分保证、低灌注持续时间长等因素使患者无神经功能损伤生存率较院内ECPR明显降低。我国人口基数大,综合国内外资料,每年60岁以下院外心搏骤停患者不低于数百万,因此提高院前ECPR的生存率大有可为。院前ECPR是资源和技术集中的项目,对医疗机构多学科诊疗能力有较高要求,院前-院内ECPR团队实施流程的优化、ECPR介入时机提前、患者的选择、ECPR后多学科诊疗能力的支持和建设、相关并发症和危险因素的管理与ECPR患者预后密切相关,脑和心脏的可恢复性是目前制约ECPR后患者生存率进一步提高的关键因素。鉴于神经功能的恢复主要取决于前期的低灌注持续时间,ECPR实施后的院内治疗主要是低温脑保护策略,但其效果尚有争议,因此,心脏功能的恢复是神经预后之外严重制约ECPR后患者生存的关键。ECPR后心脏的可恢复性可以从多角度实施,如ECPR实施后心脏自身的匹配、心脏与ECMO的匹配等病理生理问题的研究,相应对策的提出有助于提高ECPR后患者生存率。大量人口和潜在可挽救人群使ECPR技术在我国三级医院开展具有紧迫性和必要性,挑战与机遇并存。With the gradual development and popularization of extracorporeal membrane oxygenation(ECMO)in China,some prefecture-level medical institutions in China have carried out and formed their own pre-hospital extracorporeal cardiopulmonary resuscitation(ECPR)model.Although the development levels of various prefecture-level cities are uneven and the start times vary,at present,the prefecture-level hospitals in China generally go through the development process of ECMO—in-hospital ECPR—pre-hospital ECPR—professional medical recovery center.Among them,in-hospital ECPR has the advantages of timely resuscitation,guaranteed quality of resuscitation,and fast activation speed of the ECPR team,and currently has a high success rate,with a low proportion of patients with neurological complications.However,pre-hospital ECPR is more challenging,requiring the coordination between pre-hospital and in-hospital emergency forces,multidisciplinary cooperation,and the quality of resuscitation before ECPR cannot be fully guaranteed,the long duration of patient's low perfusion,and other factors make the survival rate of patients without neurological damage obviously lower than that of in-hospital ECPR.China has a large population base,and comprehensive domestic and foreign data show that there should be no less than several million cases of out-of-hospital cardiac arrest under the age of 60 every year,so there is much to be done to improve the survival rate of pre-hospital ECPR.Pre-hospital ECPR is a project of concentrated resources and technology,which has high requirements for the multidisciplinary diagnosis and treatment capabilities of medical institutions.The optimization of the implementation process of in-hospital and pre-hospital ECPR teams,the advancement of the timing of ECPR intervention,the selection of patients,the support and construction of multidisciplinary diagnosis and treatment capabilities after ECPR,and the management of related complications and risk factors are closely related to the prognosis of ECPR patients

关 键 词：体外心肺复苏 院外心搏骤停 危险因素 左心室减压 预后 

分 类 号：R459.7[医药卫生—急诊医学]