体外膜肺氧合联合血液净化技术在药物中毒或过量救治中应用的文献分析

Literature analysis on the application of extracorporeal membrane oxygenation combined with blood purification technology in the treatment of drug poisoning or overdose

目的评价体外膜肺氧合(ECMO)联合血液净化技术在药物中毒或药物过量中的应用范围及效果。方法使用计算机检索美国国立医学图书馆(PubMed)、荷兰医学文摘(Embase)、中国知网(CNKI)、万方数据、维普数据库自建库至2021年5月公开发表的有关ECMO联合血液净化技术治疗药物中毒或药物过量患者的研究报道,提取患者的基本信息、毒物种类、中毒途径、ECMO模式、开始时间、血液净化模式、持续时间及预后等资料,采用SPSS 26.0软件进行统计分析。结果共纳入45篇文献,涉及53例患者,年龄(30.51±18.04)岁。多数患者(43例)经消化道中毒;49例患者报告了具体时间,其启动ECMO时间为17.5(8.5,66.0)h,应用ECMO时间为120.0(72.0,216.0)h;39例患者采用静脉-动脉(VA)模式治疗,10例采用静脉-静脉(VV)模式,4例为VA与VV模式联合应用;28例单独采用连续性肾脏替代治疗(CRRT),应用时间为4(3,13)d,3例单独采用血液灌流(HP),4例单独采用血浆置换(PE),其余患者为两种或以上方式联合应用。42例患者存活出院,10例院内死亡,1例病情恶化自动出院;存活患者住院时间为30.0(17.0,63.0)d。结论ECMO联合血液净化技术在抢救心血管药物、精神类药物等多种药物中毒及药物过量患者中发挥了积极的作用。

Objective To evaluate the scope of application and efficacy of extracorporeal membrane oxygenation(ECMO)and blood purification as a combination therapy for the treatment of drug poisoning or drug overdose.Methods A computer retrieval system was conducted to search for studies and reports on ECMO and blood purification as a combination therapy for the treatment of drug poisoning or drug overdose that were published via PubMed,Embase,CNKI,Wanfang Data and VIP Databases from the date of database creation to May 2021.The basic patient information,drug type,route of poisoning,ECMO mode,start time and duration,blood purification mode and duration,prognosis,etc were collected from the data.SPSS 26.0 soft ware was used for statistical analysis.Results A total of 45 studies involving 53 patients with a mean age of(30.51±18.04)years old were included in this study.There were 43 cases of poisoning by ingestion through elementary canal.A total of 49 patients'specific time were reported,the ECMO start time was 17.5(8.5,66.0)hours,and the ECMO duration was 120.0(72.0,216.0)hours.The vein-artery(VA)mode was applied in 39 cases,the vein-vein(VV)mode was adopted in 10 cases,and the rest 4 cases switched between the VA and VV modes or combined use of VA and VV.In terms of blood purification,28 patients were treated by hemofiltration,3 underwent hemoperfusion(HP),4 received therapeutic plasma exchange(PE),and the rest used combined blood purification techniques more than two types.Of the 53 patients,42 cases survived and were discharged upon approval,10 cases died during the hospital stay,and one was discharged against medical advice despite the worsening condition.The mean length of stay of survivors was 30.0(17.0,63.0)days.Conclusion ECMO and blood purification as a combination therapy plays a beneficial role in the process of salvage for multiple kinds of drug poisoning(e.g.,cardiovascular drugs,psychoactive substances,etc.)and drug overdose.