体外膜肺氧合患者脑功能监测的现状及未来方向

Current satus and future direction of neuromonitoring in patients on extracorporeal membrane oxygenation

神经系统并发症严重影响体外膜肺氧合(ECMO)患者的短期和长期预后。随着ECMO应用的日益增多,ECMO患者脑功能监测受到越来越多关注。临床上神经系统检查、脑损伤相关标记物检测、经颅多普勒/经颅彩色多普勒脑血流监测、视神经鞘直径测量、近红外光谱法脑氧饱和度监测、连续脑电图监测、体感诱发电位等多种脑功能监测方法已在ECMO患者中使用,但是单一的脑功能监测手段在预测脑功能损伤的敏感性和特异性上尚存在不足。因此,重症医学以及体外生命支持多学科专家越来越提倡多模态脑功能监测,以提高监测ECMO患者急性脑损伤发生的敏感性及特异性,及早发现急性脑功能损伤并进行干预,进而提高ECMO患者预后。但目前尚缺乏多模态脑功能监测的规范化实施流程,制订ECMO患者多模态脑功能监测流程,在多中心进行验证并不断完善,将之转化为正确治疗决策是新使命。

Neurological complications significantly affect the short-and long-term outcomes of patients with extracorporeal membrane oxygenation(ECMO).With the increasing application of ECMO,more and more attention has been paid to the neuromonitoring in ECMO patients.Although many neuromonitoring approaches have already been used clinically,the sensitivity and specificity utilizing one single neuromonitoring assessment to predict brain injury is still insufficient.Therefore,multidisciplinary experts in critical care medicine and extracorporeal life support organization advocate that multimodal monitoring(MMM)should be applied to improve the sensitivity and specificity of monitoring the occurrence of acute brain injury in patients with ECMO.With timely and appropriate intervention,the prognosis of patients with ECMO may be improved.However,there is still a lack of standardized implementation procedures for MMM,which needs further efforts.With continuous verification and improvement in multi-clinical centers,the standardized MMM procedures could be transformed into correct treatment decisions,thus to improve the outcomes of patients with ECMO.