静脉-动脉体外膜氧合中左心室减压方式的研究进展

Recent advances of left ventricular unloading during veno-arterial extracorpore al membrane oxygenation

近年来,静脉-动脉体外膜氧合(V-A ECMO)越来越多地应用于难治性心源性休克患者的救治中,并被证明可明显改善患者预后。但当V-A ECMO运行时,左心室后负荷的增加,可能导致左心室扩张、心内膜缺血、心室功能恢复延迟、室性心律失常、肺水肿及左心室血栓形成等并发症。因此,在V-A ECMO应用期间,对于增加的左心室后负荷可能会带来上述严重并发症的患者,应用左心室减压技术可以预防或减少相关并发症。目前,临床上存在多种左心室减压技术,但尚无统一的应用共识,本文将就V-A ECMO应用期间左心室减压技术作一综述。

In recent years,veno-arterial extracorporeal membrane oxygenation(V-A ECMO)has been widely used for pa tients with refractory cardiogenic shock(CS)and significantly improved outcomes.However,when V-A ECMO is operated,the in creased left ventricular afterload may lead to many complications including left ventricle dilatation,endocardial ischemia,delayed ven tricular recovery,ventricular arrhythmia,pulmonary edema,and left ventricular thrombosis.Left ventricular venting could prevent or reduce related complications.At present,a variety of left ventricular unloading techniques have been used in clinical practice,but no consensus is achieved.This article will review the techniques of left ventricular unloading during the application of V-A ECMO.