体外膜肺氧合中血液异物界面作用对凝血的影响与对策

Effect and treatment of blood-material-interface interaction during extracorporeal membrane oxygenation

体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)是一种可持久的体外气体交换和循环支持技术,广泛应用于各类重症患者的心肺支持治疗。ECMO应用中血液异物界面作用引起血浆蛋白吸附接触材料表面,激活凝血途径,造成凝血功能异常,引起出血、栓塞等并发症。全身使用抗凝药物,接触材料表面抗吸附涂层、抗凝药物释放涂层等方法部分缓解和解决了血液异物界面作用。新理念的提出和新技术的应用将进一步解决血液异物界面作用,提高ECMO的治疗效果。

Extracorporeal membrane oxygenation （ECMO） is a sustainable technique with gas exchange and circulation support. It is extensively used in patients who are so severe that need cardiopulmonary support. Blood-material- interface interaction （BMII） during EGMO initiates adsorption between plasma proteins and material surface,activates blood coagulation pathway, and leads to coagulopathy and complications such as bleeding and thrombosis. Systematic application of anticoagulant drugs, anti-fouling coating on material surface, and anti-clotting drug release coating can partially relieve and solve the problem of BMII. Raising new concepts and developing new techniques will help reduce BMII and improve the therapentic effects of ECMO.