体外膜肺氧合用于羊水栓塞患者的临床进展

Progress of extracorporeal membrane oxygenation in the treatment of amniotic fluid embolism patients

羊水栓塞(amniotic fluid embolism,AFE)是一种严重危害母婴健康的急性分娩期全身过敏反应综合征,体外膜肺氧合技术(extracorporeal membrane oxygenation,ECMO)是一项用于极危重患者呼吸循环体外支持的技术,可打破多器官衰竭的恶性循环,为病因可逆的AFE患者争取心肺功能恢复的时间,改善其预后。但由于ECMO在临床应用过程中存在出血、血栓栓塞、多脏器功能衰竭等多种并发症,而AFE的临床表现之一是弥散性血管内凝血和难以控制的产后出血,所以ECMO在AFE抢救中的应用仍存在一定争议。目前尚无相关文献提出ECMO应用于AFE患者的具体禁忌证,相关前瞻性临床研究的发展亦因AFE发病率低、起病急骤、进展迅速、死亡率高的特点而受到限制,建立于1990年的世界体外生命支持组织致力于收集全球ECMO治疗患者的医疗数据,其中与AFE相关的数据内容在未来可能给出建议。

Amniotic fluid embolism （AFE） is a catastrophic acute systemic inflammatory syndrome which hurts maternal and newborn＇s health. Extracorporeal membrane oxygenation （ECMO） can slow down the vicious cycle of muhiple organ failures and buy times for the recovery of the cardiorespiratory function,especially when amniotic fluid embolism patients doesn＇t have the chronic organic disease. However,ECMO has many complications such as bleeding, thromboembolism, muhiple organ failures and the huge consumption of medical resources, which make it becomes controversial when applied to AFE resuscitation. Actually,prospective research about the use of ECMO in AFE patients is difficult due to AFE＇s low incidence, suddenly onset, acute progression, and high mortality risk. The Extracorporeal Life Support Organization （ELSO） collects data about patients treated by ECMO,and AFE related data may give responses in the future.