穿刺置管融合远程监控腹腔复苏技术救治多器官障碍的研究进展

Peritoneal catheter percutaneous placement,remote monitoring of automated peritoneal dialysis and direct peritoneal resuscitation as adjunct to conventional resuscitation for MODS

严重创伤、重症感染及脓毒症休克可继发多器官功能障碍综合征(MODS)。近年来研究发现在常规复苏基础上持续低流量腹膜透析液灌注腹腔,具有改善微循环、减轻水肿、调节淋巴回流、抑制炎症反应等直接的器官保护作用,是为一种全新的复苏方式——腹腔复苏(DPR)。日益成熟的经皮穿刺腹腔置管术与远程监控自动化腹膜透析为高效实施DPR提供可能,三种技术有机融合有望成为推动MODS救治进展的新动力。文章就穿刺置管融合远程监控腹腔复苏技术在多器官损伤救治的进展进行综述。

Multiple organ dysfunction syndrome(MODS)is most commonly a sequela to severe sepsis or septic shock,but it also develops secondary to trauma,neoplasia,or other causes of the systemic inflammatory response syndrome.It has been found that peritoneal dialysate has a direct organ protective effect after infusion into the abdomen,including improving microcirculation,promoting lymphoid reflux,reducing edema,counteracting inflammatory reaction,etc.This novel resuscitation was dubbed direct peritoneal resuscitation(DPR).Percutaneous peritoneal dialysis catheter insertion was associated with a very low complication rate and high primary success rate.Remote patient monitoring(RPM)allowing the clinical team to have access to dialysis data and adjust the automated peritoneal dialysis(APD)treatment modality.We suggest that minimally invasive percutaneous catheter insertion and RPM+APD combined with DPR have an important role in prevention and resolution of MODS.The discussion herein will review the current available literature on the research status and application progress in this field.