体外膜肺氧合在严重创伤患者救治中的并发症及其防治策略研究进展

Research progress in complications and their prevention and treatment strategies during extracorporeal membrane oxygenation support for severe trauma

体外膜肺氧合(ECMO)是一种体外支持呼吸和循环的技术。严重创伤可导致患者心肺功能衰竭,当常规治疗无效时,ECMO可在循环和呼吸衰竭的抢救过程中起到辅助作用。ECMO短期转流可迅速改善危重患者的循环衰竭和低氧血症等状态,长期转流能部分或全部替代患者的心肺功能,为心肺恢复正常运转赢得宝贵的时间。但由于创伤重症患者的机体状态和ECMO设备等原因,临床上总会产生各种并发症。创伤患者出血风险高、创面易感染、可能合并器官损伤及功能障碍,因此,创伤患者在使用ECMO支持过程中需要更为全面的并发症预防和治疗。笔者就ECMO在严重创伤患者救治中的并发症及其防治策略研究进展进行综述,为其并发症的防治提供参考。

Extracorporeal membrane oxygenation(ECMO)is a technique in which breathing and circulation are supported extracorporeally.Severe trauma may induce cardiopulmonary failure,for which ECMO can play an adjunctive role in the salvage treatment of circulatory and respiratory failure when conventional treatments are ineffective.Bypass with ECMO can rapidly improve the state such as circulatory failure and hypoxemia in critically ill patients in short term and can partially or fully replace their cardiopulmonary function in long term,winning valuable time for normal recovery of cardiopulmonary function.Because of the physical state of severe trauma patients and the ECMO equipment,there are still various complications clinically.Trauma patients show high risk of bleeding,vulnerability to wound infection and probability of combined organ injury and dysfunction,so more comprehensive measures for the prevention and treatment of complications during the use of ECMO therapy are required.The authors review the research progress in complications and corresponding prevention and treatment strategies during ECMO support for severe trauma,aiming to provide a reference to prevent and treat these complications.