体外膜氧合联合连续性肾脏替代治疗患者的临床特点及抗凝治疗  

Clinical characteristics and anticoagulation therapy of patients with extracorporeal membrane oxygenation combined with continuous renal replacement therapy

作　　者：乔莉 张奇峰 张双龙 邢晓辉 王征 Qiao Li;Zhang Qifeng;Zhang Shuanglong;Xing Xiaohui;Wang Zheng(Intensive Care Unit,Peking University International Hospital,Beijing 102206,China)

机构地区：[1]北京大学国际医院重症医学科,北京102206

出　　处：《中国体外循环杂志》2025年第2期113-117,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的探讨体外膜氧合(ECMO)联合连续性肾脏替代治疗(CRRT)患者的临床特点及抗凝治疗。方法单中心回顾性分析2022年1月至2024年5月北京大学国际医院重症医学科20例接受ECMO治疗患者的临床数据,比较其临床特点及抗凝方案。结果共纳入患者12例,死亡9例,其中体外心肺复苏患者死亡率为85.71%,急性冠脉综合征患者死亡率为60%。ECMO联合CRRT患者的并发症为出血事件(75%)及远端肢体缺血(33.33%)。12例中有8例(66.67%)使用肝素联合局部枸橼酸钠抗凝,4例(33.33%)使用局部枸橼酸钠抗凝,使用与未使用肝素抗凝的两组患者并发症发生率无显著差异(P>0.05)。结论ECMO患者中联合CRRT治疗的比例高,预后差,死亡率高,其中急性冠脉综合征患者生存率较高,出血仍是此类患者常见并发症。Objective To investigate the clinical characteristics and anticoagulation therapy of extracorporeal membrane oxygenation(ECMO)combined with continuous renal replacement therapy(CRRT).Methods Clinical data of 20 patients treated with ECMO in the Intensive Care Unit of Peking University International Hospital from January 2022 to May 2024 were retrospectively analyzed,and their clinical characteristics and anticoagulation regimen were compared.Results A total of 12 patients were included,and 9 of whom died.The mortality rate of ECPR patients was 85.71%,and that of acute coronary syndrome patients was 60.00%.The complications of ECMO combined with CRRT included bleeding events(75.00%)and distal limb ischemia(33.33%).Among the 12 cases,8 cases(66.67%)were treated with heparin combined with regional citrate anticoagulation for anticoagulation,and 4 cases(33.33%)were treated with regional citrate anticoagulation for anticoagulation.There was no significant difference in the incidence of complications among patients who were treated with or without heparin for anticoagulation(P>0.05).Conclusion The proportion of ECMO patients treated with CRRT is high,the prognosis is poor,and the mortality is high.Among them,the survival rate of patients with acute coronary syndrome is high,and bleeding is still a common complication in such patients.

关 键 词：体外膜氧合 连续性肾脏替代治疗 急性肾损伤 抗凝治疗 

分 类 号：R692[医药卫生—泌尿科学]