体外膜肺氧合在危重伤病员救治和转运中的应用及其对我军战创伤救治的启示

Application of ECMO in critically ill patients and its enlightenment for combat casualty care in our army

高科技武器的大量使用导致现代战争中极重伤员越来越多;随着战伤救治水平的大幅度提高,以往无法救治的重症战创伤得到救治;然而这一部分生命得以维系的重症伤员随即出现极危重的呼吸、循环衰竭,最终伤死率极高。

The treatment and transportation of the sick and wounded with severe cardiopulmonary failure, because of high mortality rate, is always a difficult issue in combat casualty care. Extracorporeal membrane oxygenation (ECMO), as a technique for cardiopulmonary life support, can partially support cardiac and pulmonary functions in those patients. So, ECMO has been maturely applied in the treatment and transportation of these patients in developed countries and their armies. China started late, but developed rapidly in its utilization. The characteristics of ECMO application in treatment and transportation in the foreign countries are as follows: ①ECMO can be used in all the diseases involving respiratory and circulatory failure. ②Because ECMO transport involves the critical illness, many links and far distances, complications commonly occur, even lead to death in some serious cases during the transport. In order to reduce the incidence of the transport complications, professional transport teams have been set up in large centers and armies of developed countries to undertake transport tasks. ③Corresponding to different transport distances, different transport modes are established. In wartime, air transport is often chosen. The above experience has inspired our army in the treatment of severe heart and lung failure. The ideas of enlightenment include: ①The incidence of severe respiratory failure and heart failure has been greatly increased due to the changes of injury factors in modern war and the operational environment, and application of ECMO in the treatment and transport can reduce the morbidity and mortality. ② Combining the characteristics of our military operations, ECMO can provide powerful and stable cardiopulmonary support, quickly relieve the symptoms such as hypoxia and heart failure, and fully ensure the patients' safety on the way back for dying critically ill patients, and those suffering from such as severe high altitude pulmonary edema, sea drowning and/or hypothermia, and inhalation injury. ③ Capable, professional and quickresponse ECMO teams for transport and treatment should be set up. ④There is an urgent need to establish ECMO air transport process.