体外膜氧合血液动力学监测和治疗的目标

Goals of hemodynamic monitoring and treatment in extracorporeal membrane oxygenation

近年来,体外膜氧合(ECMO)在重度呼吸及循环功能障碍患者中的应用越来越普及,而这些患者的血液动力学非常不稳定。因此,血液动力学监测及治疗是ECMO患者管理中的十分重要的组成部分。改善微循环及组织灌注是ECMO支持的目标,也是血液动力学监测和治疗的最终目标。ECMO可以增加全身组织流量,改善大循环,但大循环的改善并不意味着微循环也得到了改善,并且微循环状态与患者的预后密切相关。因此需要对ECMO患者的血液动力学进行实时监测、综合判断。维持合适的目标血压,保证稳定充足的血流量是满足组织灌注的关键。本文旨在探讨积极的监测方法评估微循环,以采取更多的治疗方法来改善微循环,从而改善ECMO患者的预后。

In recent years,the application of extracorporeal membrane oxygenation(ECMO)in patients with severe respiratory and circulatory dysfunction has become increasingly popular,but hemodynamics are very unstable in these patients.Therefore,hemodynamic monitoring and treatment are very important in the management of patients receiving ECMO.Improving microcirculation and tissue perfusion is the goal of ECMO and also the ultimate goal of hemodynamic monitoring and treatment.ECMO can increase systemic tissue flow and improve the macrocirculatory hemodynamics,but the improvement of macrocirculation does not mean that the microcirculation is also improved,and microcirculatory hemodynamics are closely related to the prognosis.Therefore,the hemodynamics of ECMO patients need to be monitored in real time and comprehensively judged.Maintaining an appropriate target blood pressure is a prerequisite.Ensuring a stable and sufficient flow is the key to tissue perfusion.It is also necessary to evaluate the microcirculation through various monitoring methods and take more available treatments to improve microcirculation,thereby improving the prognosis of patients with ECMO.