体外膜肺氧合在右心衰竭治疗中的研究进展

Research Progress of Extracorporeal Membrane Oxygenation Application in Right Ventricular Failure

右心衰竭是一种常见的临床综合征,其病因复杂,病情可迅速恶化,且死亡风险较高。若内科治疗失败,需通过机械循环辅助装置维持全身和右心室灌注。体外膜肺氧合技术(ECMO)是目前机械循环技术中最常用且可有效治疗右心衰竭的方法之一。根据不同置管方式,ECMO可分为静脉-静脉ECMO、静脉-动脉ECMO和三管路模式。不同模式的工作原理和临床疗效存在显著差异,根据右心衰竭的病理生理和临床特点选用或更改不同的ECMO模式,可改善缺氧和心功能不全,减少ECMO并发症发生,改善患者预后。因此,ECMO有望成为右心衰竭的最佳治疗方法。

Right ventricular failure is a common clinical syndrome with complex etiology,which has rapid deterioration and high risk of clinical death.If medical therapies are failed,mechanical circulatory support is needed to maintain systemic and right ventricular perfusion.Extracorporeal membrane oxygenation(ECMO)is the most efficient and effective modality of MCS.According to different catheter methods,there are three ECMO modes,including veno-venous ECMO,veno-arterial ECMO and triple cannulation ECMO.There are obvious differences in the working principles and clinical effects of the three ECMO modes,and we need to select or change different ECMO treatment modes according to the different pathophysiological characteristics and clinical status of right ventricular failure,to improve hypoxia and cardiac function,reduce complications of ECMO,and improve patient prognosis.Therefore,ECMO is expected to become the optimal treatment for right ventricular failure.